DENTAL SERVICE SUPPORT IN A THEATER OF OPERATIONS · PDF filedental service support in a ......

FM 4-02.19 (FM 8-10-19)

DENTAL SERVICESUPPORT IN ATHEATER OFOPERATIONS

HEADQUARTERS, DEPARTMENT OF THE ARMY

DISTRIBUTION RESTRICTION: Approved for public release; distribution is unlimited.

*FM 4-02.19 (FM 8-10-19)

FIELD MANUAL HEADQUARTERSNO. 4-02.19 (8-10-19) DEPARTMENT OF THE ARMY Washington, DC, 1 March 2001

DENTAL SERVICE SUPPORT IN A THEATER OF OPERATIONS

TABLE OF CONTENTS

Page

PREFACE ....................................................................................................... vii

CHAPTER 1. OVERVIEW OF DENTAL SERVICE SUPPORT ........................ 1-11-1. General .............................................................................. 1-11-2. Echelons of Medical Care ........................................................ 1-11-3. Dental Service Support Mission ................................................. 1-21-4. Categories of Dental Care ........................................................ 1-2

CHAPTER 2. ORGANIZATION OF FIELD DENTAL SUPPORT ..................... 2-12-1. General .............................................................................. 2-12-2. Types of Dental Support .......................................................... 2-12-3. Command Dental Surgeon ........................................................ 2-12-4. Dental Staff Officer Responsibilities ............................................ 2-22-5. Dental Staff Officer Positions .................................................... 2-22-6. Dental Support Within a Theater of Operations ............................... 2-32-7. Headquarters and Headquarters Detachment, Medical Battalion (Dental

Service), TOE 08476L000.................................................... 2-52-8. Medical Company (Dental Service), TOE 08478L000 ....................... 2-62-9. Medical Detachment (Dental Service), TOE 08479L000 .................... 2-8

2-10. Medical Team (Prosthodontic), TOE 08588LA00 ............................ 2-9

CHAPTER 3. FIELD DENTISTRY ............................................................ 3-1 Section I. Introduction ....................................................................... 3-1

3-1. General .............................................................................. 3-13-2. Objective ............................................................................ 3-13-3. Medical Evacuation and the Referral of Dental Patients ..................... 3-1

Section II. Field Dental Equipment ........................................................ 3-23-4. General .............................................................................. 3-23-5. Design ............................................................................... 3-23-6. Description.......................................................................... 3-23-7. Deployable Medical Systems/Hospital Dentistry .............................. 3-3

DISTRIBUTION RESTRICTION: Approved for public release; distribution in unlimited.

*This publication supersedes FM 8-10-19, 12 May 1993. i

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Section III. Area Dental Support .............................................................. 3-43-8. General ............................................................................... 3-43-9. Site Selection for the Dental Treatment Facility ............................... 3-4

3-10. Shelter ................................................................................ 3-43-11. Dental Treatment Facilities Internal Design and Layout ..................... 3-5

Section IV. Patient Care Operations ......................................................... 3-103-12. General ............................................................................... 3-103-13. Clinical Standing Operating Procedure ......................................... 3-103-14. Dental Records and Reports ...................................................... 3-103-15. Preventive Dentistry ................................................................ 3-123-16. Infection Control .................................................................... 3-143-17. Patient and Care Provider Protection ............................................ 3-143-18. Waste Management ................................................................. 3-143-19. Radiology Operations .............................................................. 3-14

Section V. Prosthodontic Care Operations................................................. 3-153-20. General ............................................................................... 3-153-21. Location of Prosthodontic Capability ............................................ 3-153-22. Clinical and Laboratory Operations ............................................. 3-15

CHAPTER 4. DENTAL SERVICE UNIT OPERATIONS ................................. 4-1Section I. Introduction ......................................................................... 4-1

4-1. General ............................................................................... 4-14-2. Medical Force 2000 Doctrine ..................................................... 4-14-3. Medical Threat ...................................................................... 4-14-4. Operational Tasks ................................................................... 4-24-5. Standing Operating Procedures ................................................... 4-4

Section II. Dental Service Support Planning .............................................. 4-44-6. General ............................................................................... 4-44-7. Planning Process .................................................................... 4-44-8. Types of Plans and Orders ........................................................ 4-44-9. Deputy Commander, Dental Service, Corps Medical Command ........... 4-5

4-10. Formats ............................................................................... 4-5Section III. Unit Movements .................................................................... 4-5

4-11. General ............................................................................... 4-54-12. Strategic Movements ............................................................... 4-64-13. Movements Within the Theater ................................................... 4-64-14. Convoy Operations ................................................................. 4-64-15. Unit Movement Plans .............................................................. 4-64-16. Procedures for Unit Movement ................................................... 4-74-17. Unit Load Plans ..................................................................... 4-7

Section IV. Provision of Dental Services ..................................................... 4-84-18. General ............................................................................... 4-84-19. Patient Population ................................................................... 4-8

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4-20. Dental Service-Related Missions ................................................. 4-9Section V. Sustainment of Dental Operations ............................................. 4-9

4-21. General ............................................................................... 4-94-22. Sustainment Planning ............................................................... 4-104-23. Support Arrangements ............................................................. 4-10

Section VI. Survival in the Combat Environment ......................................... 4-114-24. General ............................................................................... 4-114-25. Threat from Enemy or Others .................................................... 4-114-26. The Effects of the Laws of Land Warfare on Dental Service Support ..... 4-124-27. Rear Area Operations .............................................................. 4-13

Section VII. Reconstitution and Redeployment Phase of Dental Operations ......... 4-144-28. General ............................................................................... 4-144-29. Redeployment ....................................................................... 4-144-30. Reconstitution........................................................................ 4-144-31. Documentation ...................................................................... 4-14

CHAPTER 5. COMMAND, CONTROL, AND COMMUNICATIONS ................. 5-1Section I. Introduction ......................................................................... 5-1

5-1. General ............................................................................... 5-15-2. Concept of Command and Control ............................................... 5-1

Section II. Command and Control ........................................................... 5-15-3. General ............................................................................... 5-15-4. Technical Supervision .............................................................. 5-25-5. Command and Technical Supervision Chains .................................. 5-25-6. Interim Relationships ............................................................... 5-25-7. Theater Army Dental Surgeon .................................................... 5-4

Section III. Communications .................................................................. 5-45-8. General ............................................................................... 5-45-9. External Communications Support ............................................... 5-4

5-10. Alternate Communications Means ............................................... 5-4 Section IV. Communication of Dental Information ....................................... 5-5

5-11. General ............................................................................... 5-55-12. Command and Staff Communications Channels ............................... 5-55-13. Types of Dental Information ...................................................... 5-65-14. Patient Treatment Data ............................................................. 5-7

CHAPTER 6. EMPLOYMENT OF THE MEDICAL BATTALION (DENTALSERVICE) ....................................................................... 6-1

6-1. General ............................................................................... 6-16-2. Medical Battalion (Dental Service) .............................................. 6-16-3. Medical Detachment (Dental Service) ........................................... 6-16-4. Phased Employment of Dental Services......................................... 6-1

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CHAPTER 7. DENTAL SUPPORT IN STABILITY OPERATIONS AND SUPPORTOPERATIONS ................................................................. 7-1

Section I. Introduction ......................................................................... 7-17-1. General ............................................................................... 7-17-2. Overview ............................................................................. 7-1

Section II. Dental Role in Stability Operations and Support Operations ........... 7-17-3. General ............................................................................... 7-17-4. Dental Support Planning for Stability Operations and Support Opera-

tions ............................................................................... 7-2

CHAPTER 8. ADDITIONAL WARTIME ROLES .......................................... 8-18-1. General ............................................................................... 8-18-2. Training Requirements ............................................................. 8-18-3. Dental Operations Employment Options ........................................ 8-2

8-4. Individual Dental Officer Roles .................................................. 8-28-5. Dental Treatment Facilities Additional Use .................................... 8-28-6. Medical Treatment Facility Augmentation Options ........................... 8-28-7. Planning and Coordination ........................................................ 8-3

CHAPTER 9. DENTAL OPERATIONS IN A NUCLEAR, BIOLOGICAL,CHEMICAL, OR DIRECTED-ENERGY ENVIRONMENT ....... 9-1

Section I. Introduction ......................................................................... 9-19-1. General ............................................................................... 9-19-2. Mission in a Nuclear, Biological, and Chemical Environment .............. 9-19-3. Technical Guidance ................................................................. 9-1

Section II. Nuclear, Biological, Chemical, and Directed-Energy Environments .. 9-19-4. General ............................................................................... 9-19-5. Nuclear Environment............................................................... 9-29-6. Biological Environment ............................................................ 9-39-7. Chemical Environment ............................................................. 9-39-8. Radiological Dispersal Device Environment ................................... 9-39-9. Directed-Energy Environment .................................................... 9-3

Section III. Dental Unit Survival in a Nuclear, Biological, and Chemical Environ-ment .............................................................................. 9-4

9-10. General ............................................................................... 9-49-11. Principles of Nuclear, Biological, and Chemical Defense ................... 9-49-12. Nuclear-, Biological-, and Chemical-Related Clothing and Equipment ... 9-59-13. Individual Tasks ..................................................................... 9-69-14. Collective Unit Tasks .............................................................. 9-69-15. Decontamination .................................................................... 9-69-16. Dental Support During Nuclear, Biological, and Chemical Operations ... 9-79-17. Mission-Oriented Protective Posture ............................................ 9-7

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Section IV. Dental Treatment Operations in a Nuclear, Biological, and ChemicalEnvironment .................................................................... 9-8

9-18. General ............................................................................... 9-89-19. Patient Treatment Considerations ................................................ 9-89-20. Patient Protection ................................................................... 9-9

CHAPTER 10. SUPPLY AND SERVICES, MAINTENANCE, AND COMBATHEALTH SUPPORT ......................................................... 10-1

Section I. Introduction ......................................................................... 10-110-1. General ............................................................................... 10-110-2. Unit Supply and Maintenance Personnel ........................................ 10-1

Section II. Supply and Services ............................................................... 10-110-3. General ............................................................................... 10-110-4. Classes of Supply ................................................................... 10-210-5. Medical Supply Operations........................................................ 10-210-6. Unit Supply Operations ............................................................ 10-3

Section III. Maintenance ........................................................................ 10-310-7. General ............................................................................... 10-310-8. The Army Maintenance System .................................................. 10-310-9. Preventive Maintenance ........................................................... 10-3

APPENDIX A. DENTAL SERVICE SUPPORT UNDER THE MEDICALREENGINEERING INITIATIVE ......................................... A-1

A-1. General ............................................................................... A-1A-2. Dental Staff .......................................................................... A-1A-3. Dental Staff Responsibilities ...................................................... A-1A-4. Dental Staff Officer Positions ..................................................... A-2A-5. Dental Company (Area Support), TOE 08478A000 .......................... A-3A-6. Employment of the Dental Company Area Support........................... A-4A-7. Command, Control, Communications, Computers�Intelligence, Surveil-

lance and Reconnaissance ..................................................... A-5A-8. Proposed Changes to the Tables of Organization and Equipment by

Implementing the Medical Reengineering Initiative ...................... A-6

APPENDIX B. STANDARDIZED DENTAL CLASSIFICATION SYSTEM ............ B-1

APPENDIX C. QUALITY ASSURANCE PLAN ............................................... C-1C-1. General ............................................................................... C-1C-2. Quality Assurance in the Theater of Operations ............................... C-1C-3. Patient Care Evaluation ............................................................ C-1C-4. Utilization Management ........................................................... C-2C-5. Risk Management ................................................................... C-2C-6. Dental Radiology.................................................................... C-2

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APPENDIX D. SAMPLE OUTLINE FOR A CLINICAL STANDING OPERATINGPROCEDURE .................................................................. D-1

D-1. General ............................................................................... D-1D-2. Publication Format ................................................................. D-1D-3. Organization ......................................................................... D-1D-4. Directive .............................................................................. D-1D-5. Record of Changes and Corrections ............................................. D-1D-6. Annexes .............................................................................. D-2D-7. Content ............................................................................... D-2

APPENDIX E. SUGGESTED FORMAT FOR A TACTICAL STANDING OPERATING PROCEDURE .............................................. E-1

E-1. General ............................................................................... E-1E-2. Publication Format ................................................................. E-1E-3. Contents .............................................................................. E-1E-4. Directive .............................................................................. E-2E-5. Record of Changes and Corrections ............................................. E-2E-6. Annexes .............................................................................. E-3E-7. Index .................................................................................. E-3

APPENDIX F. FORCE PROTECTION STRATEGIC DEPLOYABILITY DATAFOR DENTAL SERVICE SUPPORT ................................... F-1

F-1. General ............................................................................... F-1F-2. Strategic Deployability Data ...................................................... F-1

GLOSSARY ................................................................................................ Glossary-1

REFERENCES ............................................................................................ References-1

INDEX ....................................................................................................... Index-1

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PREFACE

This publication provides basic doctrine and the tactics, techniques, and procedures required fordental service support (DSS) in a theater of operations (TO). It focuses on current combat health support(CHS) doctrine. The tactics, techniques, and procedures provided are not all-inclusive.

This publication implements and/or is in consonance with the following North Atlantic TreatyOrganization (NATO) International Standardization Agreements (STANAGs) and American, British,Canadian, and Australian (ABCA) Quadripartite Standardization Agreements (QSTAGs):

NATO ABCA STANAG QSTAG TITLE

2014 Warning Orders, Operation Orders, and Administrative Service Support Orders

520 Operation Orders, Tables, and Graphs for Road Movement

2068 322 Emergency War Surgery

2127 536 Medical, Surgical, and Dental Instruments, Equipment, and Supplies

2128 Medical and Dental Supply Procedures

2454 Regulations and Procedures for Road Movements and Identification of Move-ment Control and Traffic Control Personnel and Agencies

2931 Orders for the Camouflage of the Red Cross and Red Crescent on Landin Tactical Operations

2122 535 Medical Training in First Aid, Basic Hygiene, and Emergency Care

The use of the term �level of care� in this publication is synonymous with �echelon of care� and�role of care.� The term �echelon of care� is the old NATO term. The term �role of care� is the newNATO and ABCA term.

Users of this publication are encouraged to submit comments and recommendations to improvethe publication. Comments should include the page, paragraph, and line(s) of the text where the changeis recommended. The proponent for this publication is the United States (US) Army Medical Depart-ment Center and School (AMEDDC&S). Comments and recommendations should be forwarded directlyto Commander, AMEDDC&S, ATTN: MCCS-FCD-L, 1400 East Grayson Street, Fort Sam Houston,Texas 78234-5052, or by using the E-mail addresses on the Doctrine Literature website athttp://dcdd.amedd.army.mil/index1.htm (click on Doctrine Literature).

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The staffing and organizational structure presented in this publication reflects those established inthe Army of Excellence base table(s) of organization and equipment (BTOEs) (L-series) and the ArmyForce Projection BTOEs (A-series) that were current at the time this manual was published. However, suchstaffing is subject to change to comply with manpower requirements criteria outlined in Army Regulation(AR) 71-32 and may be subsequently changed by your modified table of organization and equipment(MTOE). Appendix A discusses in detail the BTOE (A-series) that is an important part of the MedicalReengineering Initiative (MRI) in Force XXI and how the DSS will be incorporated into that force.

As the Army Medical Department (AMEDD) transitions to the 91W military occupational specialty(MOS), positions for 91B and 91C will be replaced by 91W when new unit MTOE take effect.

Unless this publication states otherwise, masculine nouns and pronouns do not refer exclusively tomen.

The use of trade names in this publication does not imply endorsement by the US Army, but isintended only to assist in the identification of a specific product.

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CHAPTER 1

OVERVIEW OF DENTAL SERVICE SUPPORT

1-1. General

a. Dental service support is provided across the continuum of military operations�war, conflict,and peace. As with CHS, DSS conserves the fighting strength by returning dental casualties to duty as farforward as possible and minimizing the number of patients with dental injuries or disease whom must beevacuated from the TO.

b. Dental service support within the TO is accomplished with the use of modern, lightweightequipment, levels of dental care, and flexible, responsive dental organizations. To enhance the effectivenessof dental support to deployed forces, the AMEDD MRI organizational structure (see Appendix A), oncefielded, will:

� Promote dental health.

� Maximize the return to duty (RTD) of dental casualties.

� Provide a resuscitative surgical capability for maxillofacial injuries.

� Maintain the dental fitness of theater forces.

� Reinforce medical treatment facility (MTF) personnel during times of mass casualtyoperations.

c. The categories of dental care within the TO is comprised of operational emergency dental careand essential dental care. Further, one category of dental care (comprehensive care) is provided in thecontinental United States (CONUS) support base. For additional information on the categories of dentalcare refer to paragraph 1-4.

1-2. Echelons of Medical Care

Combat health support is arranged into four echelons of medical care extending from the point of injury orwounding and extending rearward through successively higher numbered echelons of care within thetheater. When patients medical conditions require evacuation out of the TO for specialized medical and/orperhaps surgical care, the CONUS support base becomes Echelon V. En route medical care is provided (asnecessary) during evacuation to sustain the patients during transit from one echelon to the next successivelyhigher numbered echelon of care. Excluding Echelon I, dental assets in the TO are established at allechelons of care. Each higher numbered echelon reflects an increase in capability, but can perform thefunctions of each lower numbered dental echelon. An explanation of the echelons of medical care isprovided in the glossary and in-depth discussion is provided in Field Manual (FM) 8-10.

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1-3. Dental Service Support Mission

Dental service support is one of the ten functional areas of CHS. As such, it contributes to the overall CHSmission of conserving the fighting strength. The DSS mission is to�

� Promote dental health.

� Prevent and treat oral disease.

� Provide far forward dental treatment.

� Provide early treatment of severe oral and maxillofacial injuries.

� Augment medical assets during mass casualty operations.

1-4. Categories of Dental Care

Within the TO, DSS provides operational care which is composed of emergency dental care and essentialdental care. Another category, normally found only in fixed facilities in the US, is comprehensive care.These categories are not absolute in their limits; they are the general basis for the definition of the dentalservice capabilities available at the different CHS echelons of care.

� Operational Care. Care given for the relief of oral pain, elimination of acute infection, controlof life-threatening oral conditions (hemorrhage, cellulitis, or respiratory difficulty) and treatment of traumato teeth, jaws, and associated facial structures is considered emergency care. It is the most austere typeof care and is available to soldiers engaged in tactical operations. Common examples of emergencytreatments are simple extractions, antibiotics, pain medication, and temporary fillings. Essential careincludes dental treatment necessary to intercept potential emergencies. This type of operational care isnecessary for prevention of lost duty time and preservation of fighting strength. Soldiers in Dental Class 3(potential dental emergencies) should be provided essential care as the tactical situation permits. Essentialcare is consistent with Echelon II CHS. (Refer to Appendix B for a discussion of dental classifications.)Dental modules organic to divisions, separate brigade-sized medical companies, and armored cavalryregiment (ACR) medical company, area support medical companies (ASMC), special forces groups (SFG),and the forward treatment section of the area support dental units are equipped to provide essential care.Essential care is also intended to maintain the overall oral fitness of soldiers at a level consistent withcombat readiness. Most dental disease is chronic and recurring. Soldier�s oral health status will deterioratefrom the day of deployment if essential care is not provided by deployed dental support. Soldiers in DentalClass 2 (untreated oral disease) should be provided essential care as the tactical situation and availability ofdental resources permit. This level of care is the highest category of operational care available in the TOand is provided by area support dental units and by Echelon II CHS dental modules depending on mission,enemy, terrain, troops, time available, and civilian considerations (METT-TC). The scope of servicesincludes definitive restoration, minor oral surgery, exodontic, periodontic, and prosthodontic procedures aswell as prophylaxis.

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� Comprehensive Care. Treatment to restore an individual to optimal oral health, function, andesthetics is considered comprehensive care. Comprehensive dental care may be achieved incidental toproviding operational care in individuals whose oral condition is healthy enough to be addressed by thecategory of care provided. This category of care is usually reserved for CHS plans that anticipate anextensive period of reception and training in theater. The scope of facilities needed to provide this level ofdental support could equal that of Echelon III medical facilities.

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CHAPTER 2

ORGANIZATION OF FIELD DENTAL SUPPORT

2-1. General

The responsibility of DSS is to maintain the soldier�s oral health by preventing and treating dental diseaseand injury. To accomplish this, dental support in the TO is organized into a flexible, modular system whichcan respond to rapidly changing conditions across the continuum of military operations.

This chapter discusses the current organizational structure of the dental assets within the TO as it is today,under Medical Force 2000 (MF2K), Table of Organization and Equipment (TOE) L-Series. (Appendix Adiscusses the changes made to MF2K by the MRI under the new TOE A-series when activated.)

2-2. Types of Dental Support

a. There are three levels of dental support in the TO�unit, hospital, and area. These levels aredefined primarily by the relationship of the dental assets attached to the CHS supporting the patientpopulation within each level.

� Unit�provided by a dental module organic to divisional and nondivisional medicalcompanies and all SFG. This module provides emergency dental treatment to soldiers during tacticaloperations.

� Hospital�provided by the hospital dental staff to minimize loss of life and disabilityresulting from oral and maxillofacial injuries and wounds. The hospital dental staff provides emergency,sustaining, and maintaining dental support to all injured or wounded soldiers as well as the hospital staff.

� Area dental support�provided on an area support basis by dental service companies.These dental units provide operational care. The dental companies are comprised of modular dental teamsthat are capable of operating separate dental treatment facilities (DTF), or by consolidating units andoperating one large facility depending upon the operational METT-TC. Other teams are employed toprovide far forward emergency and sustaining dental care.

b. Each type of support is described in this chapter.

2-3. Command Dental Surgeon

Coordination of the collective efforts of unit, hospital, and area dental support activities with the overallCHS operation is accomplished through dental representation on appropriate command and control (C2)staffs, usually in the form of a command dental surgeon. The dental surgeon is a special staff officer underthe staff supervision of the Adjutant (S1)/Assistant Chief of Staff (Personnel) (G1). In the medical brigade,the dental surgeon is a separate TOE position. In divisions, the comprehensive dental officer assigned to themain support battalion (MSB) fills this position of the division support command (DISCOM). A dental unitcommander who also serves as dental surgeon is described as being �dual-hatted.� In some cases, thedental surgeon position is not clearly identified and becomes an ad hoc arrangement. In all of these cases,

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the dental surgeon works closely with the command surgeon to accomplish his mission. Staff advocacy is acritical element in the development of a coordinated DSS system throughout the TO. Chapter 5 discussesDSS staff functions in greater detail.

2-4. Dental Staff Officer Responsibilities

a. The dental staff officer provides input to the commander on policy, procedures, and plans thatconcern the oral health and dental care of the command. He determines the resource requirements ofthe dental portion of the CHS operation plan (OPLAN) by first evaluating the mission statement againsthis available assets (both dental and personnel) that will be available in theater. He prepares the dentalportion of the CHS OPLAN based upon his real assets in theater (Refer to FM 8-55 and FM 8-42 forinformation concerning the preparation of CHS estimates and plans). He provides technical guidance ondental matters to subordinate dental resources. He monitors the oral health of the supported force populationand the readiness of all assigned dental assets (personnel and equipment). He continually evaluates CHSplans to determine dental resource requirements and adequacy of assets. Specific duties may includesurveillance of�

� Status of dental resources in the area of responsibility (AOR).

� Operational requirements of supported troops (for example, number and types of unitssupported or in the AOR; number of troops in supported units or AOR; the anticipated duration of theoperation; the tactical situation; the location and distribution of supported units; and the expressed needs ofcommanders).

� Provision of dental services to enemy prisoners of war (EPW), refugees, and others.

� Provision of dental services to other supported populations when authorized and directedto provide care.

b. The dental staff officer also serves as advisor to the commander on dental matters. On thebasis of the information received from dental surveillance, he makes recommendations concerning the statusof the oral health of the command and the delivery of dental care for OPLAN, operation order (OPORD),and policies.

2-5. Dental Staff Officer Positions

a. Division. The senior dental officer in a division is assigned to the MSB. In addition to hispatient care responsibilities, he acts as the division dental surgeon and exercises technical supervision overthe dental assets in the division forward support battalions (FSB). Dental officers in the FSB serve as dentalsurgeons to the supported maneuver brigades.

b. Separate Brigades, Medical Groups, Armored Cavalry Regiments, and Special Forces Groups.The dental officer in the medical element of these units also serves as the dental surgeon for the parent unit.

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In the medical group, there is not a dental officer assigned to the medical staff. Further, under the MRI, themedical group is eliminated in the force structure.

c. Medical Brigade (Corps: TOE 08422L100; communications zone (COMMZ): TOE 08422L200).A dental surgeon is located in the command section. He exercises technical control over dental assets inassigned hospitals and dental units subordinate to the medical brigade. Dental surgeons of corps medicalbrigades are dual-hatted as the brigade dental surgeon and provide technical supervision for unit-level dentalsupport and staff dental assets assigned within the medical brigade. A senior dental noncommissionedofficer (NCO) assigned to the security, plans, and operations section assists the medical brigade dentalsurgeon.

d. Medical Command (TOE 08611L000). There are three dental staff officers in the headquartersand headquarters company, medical command (MEDCOM).

(1) The theater MEDCOM dental surgeon establishes and disseminates Army theater policyon dental matters. He exercises technical control over all dental units in the TO through the medical brigadedental surgeons. He directs the dental service element of the headquarters and provides dental staff supportto the MEDCOM commander.

(2) The MEDCOM assistant dental surgeon is located in the dental service element of theheadquarters. He assists the MEDCOM dental surgeon by recommending policies and procedures andproviding DSS coordination with other staff elements.

(3) The MEDCOM preventive dentistry officer supports the MEDCOM dental surgeon andthe assistant dental surgeon in all staff actions. Specific duties include�

� Providing oral health surveillance information in support of policy and proceduredevelopment.

� Developing plans and orders concerning oral fitness and preventive dentistryprograms.

� Recommending treatment policies.

� Developing programs for dental support of humanitarian assistance or nationassistance.

2-6. Dental Support Within a Theater of Operations

a. Unit Dental Support. Dental personnel organic to Echelon II (see Glossary) medical unitsprovide this support. Dental units are designed under a modular concept to allow flexibility and ease ofaugmentation, reinforcement, or reconstitution. Dental elements under the modular support system(Echelon II) are organic in the area support squads of division medical companies and corps, separatebrigades and ACR, and the medical platoon of the SFG. Dental modules are also found in the area support

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squads of the ASMC located throughout the combat zone (CZ) and COMMZ. The dental modules that arethe basis of unit dental support have the capability to provide operational care that is discussed in Chapter 1.Their primary objective, however, is to return to duty (RTD) the soldier as rapidly as possible.

(1) Unit dental support organizations. The dental modules are organic to the area supportsquad in the medical companies of each division, separate brigade/ACR, SFG, and area support medicalbattalion (ASMB). Each has a general dentist and dental specialist assigned to them. Each division has onecomprehensive dentist in the dental module of the MSB medical company and a general dentist in the dentalmodule of each FSB. A dental specialist is also assigned as part of each of these modules.

(a) Dental modules. The modules in separate brigade/ACR medical companies andSFG have a general dentist and a dental specialist. Similar to the division, the dental modules in separatebrigades/ACR are in the area support squads of the medical company/troop of the support battalion/squadron. The dental module in the SFG is located in the medical platoon of the service companies of thespecial operations support battalions.

(b) Unit dental officer functions. Each main support medical company (MSMC) dentalofficer functions as the dental surgeon for his supported unit�a special staff position. In the division, thecomprehensive dentist of the MSMC is the division dental surgeon.

(c) Concept of operations. Unit dental personnel are not present in sufficient numbersto provide dental care to all the members of their supported units on a continuous basis without support fromarea support dental units. Therefore, depending on the tactical situation, it may be necessary to returnpersonnel to their units with other than definitive treatment (for example, temporary as opposed to permanentrestorations) (See Appendix B). The primary concern of unit dental personnel is to RTD the soldier asexpeditiously as possible. In planning the concept of the operation, unit level dental support is dependentupon corps-level area support dental assets in numbers sufficient enough to support the manpowerrequirement criteria for operational dental care. Unit dental support relies on corps-level area dentalsupport units for assistance in providing operational care. Modules of area dental support units alsoaugment or reconstitute unit dental elements when necessary.

(2) Dental casualties. Dental casualties in maneuver battalions are evacuated from forwardareas to the battalion aid station. Here they are evaluated and, if required, are further evacuated to theclearing station of the medical company to be seen by the dental officer assigned to the area support squad.This officer examines the patient and provides treatment necessary to return him to duty. If the treatmentrequired is beyond the capability available, the patient is evacuated or referred to the supporting corps areadental support unit or hospital, consistent with the patient�s condition and the tactical situation.

b. Hospital Dental Support. Dental personnel organic to the combat support hospital (CSH)provide TOE 08705L000, the field hospital (FH), TOE 08715L000, and the general hospital (GH), TOE08725L000.

(1) Organization. The primary mission of hospital dental sections is to minimize the loss oflife and disability resulting from severe oral and maxillofacial injuries and wounds. When patient careworkload permits, dental resources provide dental treatment to hospital patients and staff. In addition,

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treatment is provided to patients referred by other DTF and MTF when oral and maxillofacial care isrequired beyond the capability of the referring facility.

(2) Modular concept. All three types of hospitals with organic dental capabilities (CSH, FH,and GH) are organized under the modular concept. (Refer to FM 8-10-14 and FM 8-10-15.)

(3) Level of dental capability. The same level of dental capability of all three hospitals isfound in the hospital unit, base.

(4) Surgical capability. Attaching a medical team, head, and neck surgery, TOE 08527LA00,can augment the maxillofacial surgery capability in these hospitals. This team includes an oral surgeon. Aswith other units under the modular concept, the dental sections of the different hospitals are interchangeable.

c. Area Dental Support. Area support dental units provide dental service companies. As thename suggests, area dental support is provided within a designated geographic AOR. Within the AOR, areadental support units may be tasked to provide direct support (DS) to unit or hospital dental supportelements. They may also be tasked to reconstitute unit dental support modules within their unit. Areadental support represents a major share of the dental capability within the area of operations (AO).

2-7. Headquarters and Headquarters Detachment, Medical Battalion (Dental Service), TOE08476L000

a. Organization. The headquarters and headquarters detachment (HHD) is composed of threeofficers and seven enlisted members organized into two sections (Figure 2-1). The command section hastwo officers and one enlisted member and the operations administration section is composed of one officerand six enlisted personnel.

Figure 2-1. Medical battalion (dental service), TOE 08476L000.

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b. Mission. The HHD provides C2 to assigned and attached dental or other organizations such asthe preventive medical detachment. It also provides administrative, logistics, and personnel support to theheadquarters, and technical guidance to subordinate units on medical equipment maintenance and Class VIIIsupply.

c. Assignment. This unit is assigned to a MEDCOM, TOE 08611L000; medical brigade, TOE08422L; or medical group, TOE 08432L000.

d. Capabilities. This unit provides�

(1) Command and control of three to eight assigned or attached dental units.

(2) Allocation of dental resources (personnel and equipment) to ensure the adequacy ofdental service to all units within the assigned AOR.

(3) Technical expertise, coordination, and support to subordinate units for accomplishingtheir medical equipment maintenance and Class VIII supply mission.

(4) Current information concerning the dental aspects of the combat service support (CSS)situation to higher headquarters.

e. Basis of Allocation. One per three to eight subordinate dental service organizations.

f. Mobility. This unit is capable of transporting 50 percent of its personnel and equipment in asingle lift using organic vehicles.

2-8. Medical Company (Dental Service), TOE 08478L000

a. Organization. The medical company (dental service) has 16 officers and 43 enlisted membersorganized into four sections�

� Headquarters and support section;

� Dentistry/prosthetic sections;

� General dentistry section; and

� Forward dental treatment section (Figure 2-2).

The company is modular in design and provides DSS on an area support basis within its AOR.

(1) The headquarters and support section is composed of officers (the commander and theexecutive officer) and enlisted individuals (the company�s senior NCO, along with support personnel).These support personnel specialize in nuclear, biological, and chemical (NBC) operations; unit supply;

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combat health logistics (CHL); administration; and automotive, power generation, and medical equipmentmaintenance. A cook is assigned, but as the company does not have the capability for independent fieldfeeding, the cook is generally attached to the supporting field feeding facility.

(2) The dentistry/prosthetics section has a prosthodontist and three general dental officers, adental facility NCO, preventive dental specialists, dental laboratory personnel, and supporting dentalspecialists. The medical company (dental service) commander also acts as the chief of the dentistry/prosthetics section.

Figure 2-2. Medical company (dental service), TOE 08478L000.

(3) The general dentistry section has a comprehensive dental officer as chief, three generaldental officers, a dental facility NCO, preventive dental specialists, and supporting dental specialists.

(4) The forward dental treatment section is organized into six independent dental moduleswith organic power and transportation.

b. Mission. This unit provides operational care consisting of emergency, and essential dentalcare.

c. Assignment. This unit is assigned to the HHD, medical battalion (dental service), TOE08476L000.

d. Capabilities. This unit provides operational care, including prosthodontic specialty care. It iscomposed of one to eight field DTF consisting of one or two base DTF providing operational care and up to

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six dental treatment modules which can reinforce or reconstitute the division dental modules, whennecessary. It can support small or forward troop concentrations. The unit also provides unit maintenanceof organic equipment for the HHD, medical battalion (dental service), TOE 08476L000. It is capable ofaugmenting the advanced trauma management (ATM) capabilities of other MTF during mass casualtysituations.

e. Basis of Allocation. One per 20,000 troops supported.


2-9. Medical Detachment (Dental Service), TOE 08479L000

a. Organization. The medical detachment (dental service) is organic to the medical battalion(dental services) TOE 08476L000. Its mission is to provide operational care consisting of emergency andessential care on an area support basis within a TO. (Figure 2-3).

Figure 2-3. Medical detachment (dental service), TOE 08479L000.

(1) The headquarters and support section is roughly similar to that of the company, butsmaller. The commander of this unit is a comprehensive dentist and the facility chief is an NCO. There isno executive officer. This section includes personnel for administration; CHL; and automotive mechanic,power generation, and medical equipment maintenance; however, it has no field feeding capability. Thedetachment has no assigned cook or unit supply NCO.

(2) This unit provides dental treatment modules to reinforce or reconstitute the divisiondental modules when necessary and to operate the field dental clinic. Up to three dental treatment modulescan be provided for small or forward troop concentrations.

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(3) The forward dental treatment section is organized into three independent dental moduleswith organic power and transportation.

b. Mission. This unit provides operational care consisting of emergency and essential dentalcare.

c. Assignment. This unit is assigned to the HHD, medical battalion (dental service), TOE08476L000.

d. Capabilities. This unit provides operational care for 8,000 troops. It is composed of from oneto four field DTF. These consist of a base DTF providing operational care and up to three dental treatmentmodules to reinforce or reconstitute the division dental modules, when necessary, or provide operationalcare for small or forward troop concentrations. The unit is capable of augmenting the ATM capabilities ofother MTF during mass casualty situations.

e. Basis of Allocation. One per 8,000 troops.


2-10. Medical Team (Prosthodontic), TOE 08588LA00

The medical team (prosthodontic) is a MF2K equivalent to the H-edition TOE unit, team headquarterscompany HC, dental service augmentation, removable prosthodontic; and team headquarters detachmentHD, dental service augmentation, fixed prosthodontic. It incorporates the consolidation of the removableand fixed prosthodontic specialties.

a. Mission. This unit provides additional prosthodontic dental support, when required, byaugmenting existing dental and hospital units.

b. Assignment. This unit is assigned to the medical brigade (CZ) or medical brigade (COMMZ)with further attachment to a medical battalion (dental service).

c. Capabilities. This unit provides additional fixed and removable prosthodontic support.

d. Basis of Allocation. The unit provides support for up to 40,000 troops.

e. Mobility. This unit is capable of transporting 33 percent of its personnel and equipment in asingle lift using organic vehicles. The unit is capable of transporting 4,000 pounds of equipment. It has2,789 pounds of TOE.

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CHAPTER 3

FIELD DENTISTRY

Section I. INTRODUCTION

3-1. General

The practice of dentistry in a TO requires employment of the same fundamental skills and standards ofpractice as would be employed in a garrison clinic. The limitations imposed by the availability of equipmentand the demands of the tactical situation require flexibility and expediency on the part of both the dentist andancillary personnel. Dental commanders at all echelons must establish a sound quality assurance plan asdescribed in Appendix C.

3-2. Objective

The primary objective of field dentistry is twofold:

� Attend to the soldier�s dental needs as expediently as possible.

� Return the dental patient to duty as quickly and as far forward as possible.

a. Far forward treatment teams eliminate the need to evacuate most dental emergencies to therear. During combat, the situation may permit only temporary alleviation of pain and suffering.

b. Under less demanding circumstances, the situation may permit more definitive treatment. Inall cases, the dental practitioner must accomplish as much as possible in a single sitting to avoid return visitsand subsequent lost duty time. This necessity places a greater emphasis on the professional judgment of thedental practitioner and a need to reconcile the patient�s needs with the tactical situation.

c. The field DTF should be organized to accomplish only those tasks that are absolutely necessaryfor the completion of the supported units� assigned missions.

3-3. Medical Evacuation and the Referral of Dental Patients

One of the goals of forward dental treatment is to eliminate the need for evacuation of dental patients to therear. There are times when dental patients will require medical evacuation. At other times, there will be aneed, depending on the tactical situation, for expeditious RTD after the accomplishment of emergencytreatment and subsequent referral when the tactical situation permits. The following definitions are provided:

a. Medical evacuation is the timely, efficient movement and en route care by medical personnelof the wounded, injured, or disease and nonbattle injury (DNBI) persons from the battlefield and otherlocations to a MTF/DTF. The gaining MTF is responsible for arranging for the evacuation of patients fromthe lower echelon of care. Dental patients will not require en route medical care when being transferred toa higher echelon of care; general transportation vehicles may be used.

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b. Referral is the process of referring a patient from a lower echelon of treatment for follow-uptreatment at a higher echelon when the tactical situation permits. Generally, transportation to a referralDTF is the responsibility of the higher echelon. (See FM 8-10-6 for evacuation procedures.)

c. Return to duty assumes that a soldier is capable of performing his mission in a combatenvironment. Soldiers who cannot RTD, or who require pharmaceutical regimens that impair performance,may be evacuated to the next higher echelon of care if necessary. A dental patient may be held in a forwardsupport medical company (FSMC) or a MSMC for up to 72 hours rather than being evacuated.

This section implements STANAG 2127 and 2128 and QSTAG 535 and 536.

Section II. FIELD DENTAL EQUIPMENT

3-4. General

Field dental equipment is organized into dental equipment sets (DES) and dental instrument and supply sets(DISS). In the Deployable Medical System (DEPMEDS)-equipped hospitals, the dental staff is equippedwith DEPMEDS dental materiel sets (DMS), plus additional support equipment.

3-5. Design

Dental sets are designed to ensure that the current standards of care are met; however, other importantfactors are also considered.

Those factors are�

� Mobility considerations, such as weight, and cubic volume.

� Power requirement for the dental sets.

� Equipment to withstand the rigors of field deployment should those current standards bechanged.

3-6. Description

The unit�s TOE shows the type and quantity of DES/DISS/DMS authorized. Current authorized contentsfor each set are listed in the appropriate DA supply catalogs.

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a. Dental Instrument and Supply Sets, Emergency Care. Every dental officer in a TOE clinicalposition is assigned a DISS, emergency treatment, and field. This small dental emergency kit is containedin a hand-carried medical aid bag. It contains the bare minimum of instruments and materials for simpleextractions and expedient temporary restorations. Essential in this kit is the battery-operated handpiece,which allows the dental officer to open an infected tooth, prepare a cavity for temporary restoration, orsection a tooth for extraction. The DISS, emergency treatment, field is intended for use when the situationdoes not permit the setup of the dental officer�s standard equipment.

b. Dental Equipment Set, General Dentistry Field. This DES is the backbone for providingoperational care. The field dental equipment associated with this DES is compact, rugged, and has a limitedpower demand. Every dental officer in a TOE clinical position is issued this DES.

c. Dental Support, Dental Equipment Set. This set is found in both the area support treatmentplatoon and the medical company (dental services). It contains items which can be shared in a clinicalenvironment (area support treatment platoon), and is issued to each forward treatment team. It providesnecessary support items that include a curing light, composite resin, electric pulp tester, sterilizer, sink,laboratory table, oxygen, and an emergency medical resuscitation kit.

d. Dental Instrument and Supply Set, Emergency Treatment Field. This small set provides basicmaterials for expedient denture repairs.

e. Dental Hygiene, Field, Dental Equipment Set. This set includes those instruments and materialsnecessary for providing preventive dentistry services by the preventive dental specialist.

f. Dental X-ray, Field, Dental Equipment Set. This set, along with its associated 70 kilovolts(kV), 7 milliamperes (mA) x-ray apparatus, provides a standard dental x-ray capability for the area supporttreatment platoon.

g. Prosthodontic, Dental Equipment Set. This set provides clinical and laboratory items necessaryto support fixed and removable prosthodontic procedures. (This set is described in detail in a laterdiscussion of prosthodontics in the TO.) The prosthodontics DES must be used in conjunction with thegeneral dentistry DES.

3-7. Deployable Medical Systems/Hospital Dentistry

The DEPMEDS initiative is a joint-service response to a congressional mandate to standardize Echelons IIIand IV (see Glossary) hospital medical equipment throughout the TO. The DEPMEDS is managed by theJoint Readiness Clinical Advisory Board under the direction of a joint-service committee made up of ageneral officer representing each Service.

a. Patient-Condition Based. The configuration of both the DEPMEDS medical materiel sets(MMS) and the DMS is based on a listing of patient conditions determined from sophisticated modeling.The MMS and DMS were designed, based on standardized treatment protocols developed by panels ofconsultants representing each Service, to treat selected patient conditions.

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b. Dental Materiel Sets. The DEPMEDS DMS provides the comprehensive dentist the capabilityto furnish operational care to patients.

c. Oral and Maxillofacial Surgery. Current DEPMEDS configuration requires the hospital oralsurgeon to access any, or all, of three MMS and the DMS, hospital dentistry, to treat maxillofacial patients.The three MMS are�

� Operating room.

� Ear, nose, and throat augmentation.

� Central Materiel Service echelons above corps (EAC) augmentation.

Section III. AREA DENTAL SUPPORT

3-8. General

The practice of dentistry in the TO requires employment of the same fundamental skills and standards ofpractice as would be employed in a garrison clinic. The limitations imposed by the availability of equipmentand the demands of the tactical situation require flexibility and expediency on the part of both the dentist andancillary personnel. Dental commanders at all echelons must establish a sound quality assurance plan asdescribed in Appendix C. The medical company (dental service) is one of the three types of dental unitsassigned or attached to the medical battalion (dental service) capable of providing dental service. The othertwo are the medical detachment (dental service) and the medical team (prosthodontics). Of the three areasupport dental service providers, the medical company (dental service) contains the greatest capability.Principles of employment for the medical company (dental service) are the same for those in the CZ as forthose in the COMMZ. It is likely, however, that COMMZ units will be dispersed over a wider area.

3-9. Site Selection for the Dental Treatment Facility

Site selection of this clinic is based on the anticipated length of the operation, terrain, unit(s) to besupported, and guidance from the base cluster commander and/or the base cluster operations center. Otheroperational considerations for this DTF are the responsibility of the unit commander based on his missionand the tactical situation. These operational considerations are discussed in Chapter 4. Actual site selectionis the responsibility of the officer in charge (OIC) of a DTF. Site selection considerations for a DTF are thesame as those for a MTF and are contained in FM 8-10-1.

3-10. Shelter

The practice of operational dental care requires shelter from the elements and some degree of environmentalcontrol. It is an important consideration in both site selection and the type of shelter used. Dental units and

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Echelon II medical units with organic dental assets are equipped with tentage and associated environmentalsupport items authorized in the common table of allowances (CTA) of the particular unit. Tentage,however, is not the best form of shelter for the DTF. Possibilities for shelter of the DTF are shown belowin their order of desirability.

a. Semipermanent Construction. Circumstances, particularly in long-term stability operationsand support operations, may permit semipermanent DTF construction.

b. Buildings of Opportunity. Whenever possible, DTFs should be located in suitable buildings ofopportunity. Though this may present a challenge in the DTF layout, buildings of opportunity offer obviousadvantages as opposed to using tentage.

NOTE

A building of opportunity should be inspected by the supportingengineers to ensure it is structurally sound before occupation.

c. Tentage. Tentage is the most likely shelter option available for DTF location, particularly forforward-deployed DTF and during high-tempo operations. Tentage is the option most amenable tocamouflage and concealment and offers the most flexibility in site selection.

d. Expedient Shelter. Expedient shelter is the most likely location for providing emergency carewhile on the move between locations and when dental equipment is not available. An expedient shelter maybe as simple as a shaded area or the tailgate of a vehicle.

3-11. Dental Treatment Facilities Internal Design and Layout

Once a site and type of shelter have been selected for the DTF, actual layout of the facility and internaldesign are largely determined by the allotted space, type of terrain, anticipated duration of occupation,number of shelters to be used, power distribution capability and equipment, and staff assigned. Shownbelow are suggested layouts and internal designs for DTF (see Figures 3-1 through 3-4). These illustrationsuse the organic resources and authorized CTA tentage of the DTF.

a. Dentistry/Prosthetics Section, Medical Company (Dental Service). Figures 3-1 through 3-4illustrate a variety of clinical operatories, dental laboratory, and x-ray layouts.

b. Forward Treatment Team, Forward Treatment Section. The forward treatment team isauthorized a general-purpose, small tent and a 5 kilowatt (kW) generator. It is the same size as the x-raytent.

c. Echelons III and IV Hospital Dental Treatment Facilities. Layout and design of the DTF inhospitals and medical companies are dependent upon the overall plan of the parent unit.

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Figure 3-1. General purpose, medium tent, treatment tent #1.

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Section IV. PATIENT CARE OPERATIONS

3-12. General

Once the DTF has been established, patient care operations are accomplished in much the same fashion, asthey would be in a garrison dental clinic. The overall objective, as stated earlier, is to RTD the soldier asexpeditiously as possible while at the same time attending to his dental needs. Efficient patient flow throughthe DTF will help achieve this objective.

3-13. Clinical Standing Operating Procedure

Each operational DTF should develop a clinical standing operating procedure (CSOP) (see Appendix D),separate from the unit�s tactical standing operation procedures (TSOP) (see Appendix E), that establishespolicy on such matters as patient care, patient flow, responsibilities, equipment operation and maintenance,safety directives, and other pertinent matters. The unit�s TSOP will provide specific guidance on operationalmatters.

3-14. Dental Records and Reports

Maintaining complete and accurate patient treatment records and producing dental program reports are asnecessary for quality dental care and resource management in the TO as they are in garrison. TechnicalBulletin, Medical (TB MED) 250 and AR 40-66 provides specific guidance on completing dental records.Dental personnel will follow procedures for dental records and reports prescribed by higher headquarterspolicy. In the absence of an established policy unique to an operation, the procedures outlined in thismanual will serve as guidance.

a. Field Medical Card, Department of Defense (DD) Form 1380. In Echelon I, the Field MedicalCard (FMC) is used to record the basic patient identification data and to describe the problem requiringmedical attention and the medical care provided. The FMC is made so that it can be attached to thecasualty. (See FM 8-10-6 and 8-10-1 for complete details in completing the card.)

b. Dental Treatment Facility Dental Log. A logbook is maintained for each DTF. It will includethe name, rank, and unit of the patient and the date and approximate time of the visit. It also includes a briefdescription of the reason for the visit and whether the condition was for DNBI or battle injury (BI). This logis retained for the clinic record.

c. Dental Treatment Facility Daily Dental Treatment Log. A daily dental treatment log will bemaintained by the dental officer to record procedures performed and other pertinent information regardingthe patient. This log provides a valuable source of data for statistical reporting.

d. Patient Record. The patients dental record will be maintained on DA Form 3444-series andwill not be deployed with the unit. It will be retained and maintained at the home station in accordance with

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AR 40-66 and TB MED 250. For medicolegal reasons, complete patient records in the TO remainessential. Each patient�s diagnosis and treatment, regardless of Service or country, will be accurately andcompletely recorded on a Standard Form (SF) 603A as a temporary record.

(1) To ensure that these temporary records are eventually combined with the permanentdental record, special care must be taken to ensure that a patient�s full name, social security number,service, home station, and organization unit are entered on to the record. Organizational unit shouldinclude the designation of the company, battalion, and the unit (for example, �Company D/2d Battalion, 3rdInfantry Division�).

(2) A complete description of the diagnosis and treatment includes an indication of thecategory of operational care�emergency or essential care as described in Chapter 1. As noted in paragraph3-14b above, this description will also reflect the nature of the condition and whether it was a DNBI or BI.

(3) If SF 603A is temporarily not available, ensure that all information usually provided onthe SF 603A is included on an alternative form or paper. There should be a separate SF 603A, oralternative, for each patient.

(4) All SF 603A or alternate forms will be submitted monthly and/or at the completion of theoperation or exercise to the dental surgeon. If a record must be retained beyond the end of the month forcontinuity of care, it will be forwarded with the following month�s submission.

(5) The SF 603A (or other temporary patient records) is not to be returned directly to thehome station. They will be transferred to the theater, area, exercise, or task force/ division/corps surgeon.The dental surgeon will arrange for transfer to permanent dental records at the home station after data arecollected from them.

e. Daily Dental Unit Status Report. A brief summary of the current dental situation is submitteddaily through command and dental technical channels. The report serves to keep C2 channels up-to-date onthe status of dental operations and problems concerning personnel, equipment, supply, facilities, and otheractivities. For additional information, refer to Section IV of Chapter 5.

f. Quarterly Dental Activities Report. A summary of the unit DTF, hospital DTF, or dentalsupport unit activities will be submitted by the 15th of the month following each fiscal quarter of the year bythe division/corps surgeon. For example, by 15 October, each hospital DTF, unit-support (for example,divisional and corps) DTF, and each area support dental unit will submit a report covering the period 1 Julythrough 30 September. If participation in an operation or exercise ends before the end of a quarter, the finalDental Activities Report will be due 15 days after return to the home station. The Dental Activities Report willinclude�

(1) Dates of report period.

(2) Name and location of unit or DTF.

� Description of facilities.

� Dental unit or DTF movement during report period.

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(3) Personnel (include name, rank, and area of concentration [AOC], for officer or MOSfor all enlisted personnel).

� Identity OIC and noncommissioned officer in charge (NCOIC).

� Date of arrival and departure of all personnel.

� Awards, honors, and achievements.

(4) Dental and organizational equipment for deficiencies, excesses, problems, and recom-mendations.

(5) Supply and maintenance, to include deficiencies, excesses, problems, and recom-mendations.

(6) Name of units supported, to include date support began and date support terminated.

(7) Activities and programs (for example, humanitarian assistance, preventive programs,professional and unit training, and distinguished visitors).

(8) Suggestions for improvement.

The Dental Activities Report is intended to keep higher levels informed of the status of dental resources andactivities. It is also an opportunity for dental providers to let problems and solutions be known. After acomplete initial report is submitted, subsequent reports need not repeat information that has not changed.Unless changes are indicated on subsequent reports, it will be assumed that data in the previous reports arestill valid and serve as a cumulative record of dental service for that unit.

g. Health Record-Dental, Daily Dental Unit Status Report, and Quarterly Dental Activities Report.These reports are submitted through the command and through the next higher level�s dental surgeon to theArmy Service Component Command or theater dental surgeon. The DTF dental logistics is retained at thedental facility and is available for audit if needed. Each MEDCOM and dental command surgeon extractdata and information needed for their immediate resource management and professional policy needs beforeforwarding to the next higher level. Summarizing statistics for the Daily Dental Activities Report is theonly numerical manipulation required at the DTF level. Dental surgeons and dental commanders willextract further information they require from the Health Record-Dental and the Quarterly Dental ActivitiesReport.

3-15. Preventive Dentistry

Military preventive dentistry incorporates primary, secondary, and tertiary preventive measures taken toreduce or eliminate oral conditions that decrease a soldier�s fitness to perform his mission and cause absencefrom duty. The combination of dental care measures for all soldiers is described under a preventivedentistry umbrella known as the Dental Combat Effectiveness Program (DCEP). Before operational

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deployment, these preventive dentistry measures include the Basic Combat Training/Advanced IndividualTraining Dental Program (a program to treat Class 3 patients), the Soldier Readiness Program (described inAR 600-8-101), and the preventive dentistry programs described in AR 40-35. During DSS to militaryoperations, the DCEP measures include�

� Field management of the category of dental care (see paragraph 1-4).

� Commander information on the dental fitness profile of his unit (see AR 40-35).

� The Field Oral Hygiene Information Program (see paragraph 3-15a below).

� The Dental Combat Effectiveness Monitoring Program (see paragraph 3-15c below).

a. Field Oral Hygiene Information Program. All processing locations for deployment of troopsto a TO will provide oral health information specific to the geographic area and conditions of the operationalenvironment. In addition, it is vitally important to provide oral health information in the TO at everyopportunity. When appropriate, both group and individual counseling should be used. Concepts to becovered include the importance of oral hygiene to combat fitness; the use of fluoridated toothpaste; alternativemethods of hygiene in the absence of garrison-type facilities; and procedures to seek dental services in theTO. Soldiers should also be informed that dental floss, toothbrush, and fluoridated toothpaste are availablein the Ration Supplement, Sundries Pack, Type I. These and other oral hygiene aids are also available inthe post exchange.

b. Prophylaxis Treatment. Instruments and materials for dental prophylaxis treatment are locatedin the dental hygiene, general dentistry, and endodontic and periodontal DES. A sonic prophylaxishandpiece connects to the dental treatment unit.

c. Dental Combat Effectiveness Program. The effectiveness of the DCEP depends on all elementsdescribed above. The desired outcome is to reduce the degradation of combat effectiveness from dentaldiscomfort and absence from duty station. The outcome measurement of DCEP is the unit or area dentalemergency rate. For it to be meaningful, there are three elements to consider in calculating the emergencyrate�number of emergencies, number of troops supported, and length of time supported. The emergencyrate is normally expressed as�

�Dental Emergencies/1000 Troops/Year�

For the purposes of managing the operational fitness of their troops, unit commanders have a need to knowthe dental emergency rate; they also have a need for advice from the dental surgeon on the correctiveactions required. Based on studies of previous military operations by ground forces, the following can beused for reference purposes in discussing emergency rates:

� Units with optimal oral health�75/1000/year.

� Units with adequate oral health�150/1000/year.

� Units with oral health that may degrade operational effectiveness�300/1000/year.

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3-16. Infection Control

Infection control is a critical requirement in a field environment. The demands for infection controlincreases under field conditions. Expediency and compromise do not justify potential iatrogenic inoculationwith a disease such as hepatitis, which can make a soldier combat ineffective for a long period oftime. Field sanitation in the DTF area is an important adjunct to infection control and is covered in Chapter4. Technical Bulletin MED 266 provides specific guidance on infection control, also see FM 21-10 and 21-10-1.

3-17. Patient and Care Provider Protection

Universal precautions must be used by all dental personnel. Capability for barrier protection for preven-tion of cross-contamination is included to varying degrees in each treatment DES. In the DISS, emergencytreatment, barrier protection is limited to gloves, mask, and eye protection. The larger DES have muchgreater capability, to include gloves, masks, eye protection, clinical gowns, and plastic aprons for thecare providers. Rubber dam armamentarium, eye protection, and towels and napkins are provided forthe patient. A variety of disinfection and heat sterilization capabilities are also included in the largersets.

3-18. Waste Management

The accumulation and disposal of waste of all types is a major problem on the battlefield. Proper handlingand disposal of waste is required to protect the force and the environment and to fulfill agreements with thehost nation. In general terms, the unit generating the waste is responsible for its collection and disposal.However, assistance in the physical removal and disposal is normally available through the supportingengineer unit, the preventive medicine (PVNTMED) team, or the local MTF. The types of waste generatedby dental treatment teams are general, hazardous and medical waste. Refer to FM 8-10-1 for additionalinformation on the handling of human, medical, and wastewater.

3-19. Radiology Operations

Radiology operations are an integral part of dental treatment. Capability for dental radiography is found inboth the sustaining and the maintaining care DES. Radiology operations pose a significant safety hazardand are rigidly regulated. Safety is the greatest consideration in the operation and the location of radiologyoperations within the DTF.

a. Capabilities. Radiographs are an important tool in diagnosis. The standard dental radiologyunit is currently found in the medical company (dental service) and forward treatment sections. It has a tubevoltage of 70 kV and a tube current of 7 mA. Used with the developer found in the field DES, radiology,the unit is capable of producing a full range of intraoral radiographs. In addition, the dental x-ray machinecan also be used to expose medical films if required film, film holder, and developing capability areavailable.

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b. Clinical Operation. Tables of organization and equipment provide dedicated dental specialistsfor radiology operations in the dentistry/prosthetic and general dentistry sections of the medical company(dental service) and the general dentistry section of the medical detachment (dental service). In the dentalmodules, radiology is an additional responsibility of the assigned dental specialist. Dental specialistsreceive training in x-ray techniques during their MOS training; however, instructions that come with the x-ray machine should be readily available and followed accordingly. Within the larger DTF, the x-raymachine is located in an isolated area at least 50 feet from the rest of the facility, with the beam aimed awayfrom the DTF and other adjacent populated areas. Use of a patient apron and a lead shield is mandatory.Manufacturer�s guidelines for the care and handling of radiographs and developing chemicals should becarefully followed and made a part of the standing operating procedure (SOP).

Section V. PROSTHODONTIC CARE OPERATIONS

3-20. General

There will be patients in the TO who require prosthodontic treatment. An edentulous patient who has eitherlost or broken his denture, or a patient who has an unserviceable fixed prosthesis causing pain anddiscomfort, is as much a dental casualty as a patient with a classic toothache. For this reason, vary-ing degrees of capability for both fixed and removable prosthodontic treatment are incorporated into theDTF.

3-21. Location of Prosthodontic Capability

With the exception of the dental officer providing emergency care using only the DISS, emergency care, allDTF within the TO have some capability for prosthodontic care.

a. The DES organic to each dental team has material for temporary fixed prosthodontic coverageand cementation. Additionally, each forward treatment section of the medical company (dental service) isequipped with an emergency denture repair kit for prosthodontic repairs.

b. Capability for fixed and removable prosthodontics is found in the medical company (dentalservice) and Echelon III and IV hospitals.

3-22. Clinical and Laboratory Operations

a. Clinical Operations. The medical team (prosthodontics) is capable of providing a wide rangeof fixed and removable prosthodontic services. The prosthodontist has access to a DES, general dentistryand a DES, prosthodontics.

(1) Primary fixed prosthodontic procedures, which can be accomplished with the materialavailable to the prosthodontist, include�

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� Metal and porcelain-fused metal crowns.

� Fixed partial dentures.

� Prefabricated and cast post and cores.

� Provisional restorations.

� Fixed prosthodontic repairs.

(2) Primary removable prosthodontic procedures include�

� Conventional and immediate complete dentures.

� Resin and resin/metal removable partial dentures.

� Relining and rebasing.

� A wide range of removable prosthodontic repairs.

b. Laboratory Operations. The prosthetic section of the medical company (dental service) andmedical team (prosthodontic) both have organic dental laboratory specialists who directly support theprosthodontist and the comprehensive dentists. Necessary dental materials and laboratory equipment arefound in the DES, prosthodontic. The key to the TO dental laboratory concept is the use of the Army PostOffice System for mailing patient requirements back to CONUS area dental laboratories (ADL) forfabrication. Theater laboratory capability is limited to those procedures that must be performed locally forexpediency, or those that are not suitable for mailing.

(1) These procedures involve�

� Wax records and bases.

� Impression procedures and cast fabrication.

� Stain and glazing.

� Immediate transitional resin dentures.

� Die fabrication and trimming.

� Relining/rebasing.

� Repairs.

(2) Use of the CONUS ADL for resource intensive laboratory procedures provides greatsavings in field equipment/weight and contributes to the overall mobility of the unit. Procedures such ascrown and fixed partial denture fabrication and fabrication of metal frameworks for removable partialdentures are not suited to field units and are best accomplished in CONUS ADL.

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CHAPTER 4

DENTAL SERVICE UNIT OPERATIONS


4-1. General

The medical company (dental service) provides operational care consisting of emergency and essential carewithin the TO on an area support basis. Chapters 4 and 5 focus on these operations. Dental service supportis an integral part of CHS, which in turn is part of CSS. As with CHS and CSS, DSS operations areconducted in accordance with the Army�s current doctrine for MF2K.

4-2. Medical Force 2000 Doctrine

Field Manuals 8-42, 8-55 and 8-10 is compatible with MF2K doctrine and provides the basis for the dentalcommander�s operational considerations.

a. Operational Continuum. The operational continuum encompasses the variety of conditionsand ranges within each of the threat environments in which the US military traditionally operates. The fullrange of military operations includes all environments�from stability operations and support operations towar; there may be no precise distinction between where one state ends and another begins. Dentalinvolvement can be expected in all instances of military involvement. Dental operations within theseoperational areas are covered separately in Chapter 7. Refer to FM 8-42 for additional information on thesustainment of forces in stability operations and support operations. All of the demands mentioned abovecome in addition to the constant requirement for the Army to maintain combat readiness in all forward-deployed and CONUS-based units.

b. Medical Force 2000. The tenets of MF2K apply equally to dental operations. As an elementof CSS, dental operations must complement the maneuver commander�s plan at all levels. It is imperative,therefore, that dental commanders understand the overall OPLAN and maintain situational awareness of thetactical operations.

c. Depth. The dental service plan will provide dental support throughout the battlefield.

d. Agility. The medical company (dental service) should be capable of responding to a rapidlychanging tactical situation.

e. Synchronization. Dental support should complement the CHS plan and the tactical plan as partof an overall force unity of effort.

4-3. Medical Threat

Threat analysis is a basic step in plan formulation and subsequent execution. Of particular importance to thedental commander is analysis of the medical threat. The medical threat is the composite of all ongoing or

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potential enemy actions and environmental conditions that reduce the performance effectiveness of thesoldier. Enemy combat operations that disrupt or threaten the survival of dental units are a direct threat todental operations; however, this threat is not considered part of the medical threat.

a. Elements of the Medical Threat. These categories include�

� Environmental injuries and conditions. This includes heat and cold injuries resultingfrom inadequate acclimation to the AO and inadequate clothing and equipment for the environmentalconditions. This may also include occupational hazards such as carbon monoxide, toxic industrial chemicals,and noise.

� Endemic and epidemic diseases in the AO. This includes diseases of military significance,diarrheal diseases caused by drinking contaminated or impure water (not adequately treated), eatingcontaminated foods, and not practicing good individual and unit PVNTMED measures. These diseases mayalso be the result of disease transmission by arthropod vectors.

� Diseases and injuries caused by contact with wild animals, domesticated animals, reptiles,and poisonous or toxic plants.

� Diseases and injuries caused by physical or mental unfitness. These conditions mayoccur from continuous operations, inadequate diet, and mental stressors.

� Diseases and injuries resulting from exposure to NBC agents to include biological warfareand chemical warfare agents.

b. Oral Health Threat. The oral health threat results from chronic disease that is endemic inAmerican service members. Acute narcotizing ulcerative gingivitis, acute pericoronitis, and periodontalabscesses are known to exacerbate during periods of fatigue, nutritional deficiencies, poor oral hygiene, andphysical and psychological stress. Milder gingival and periodontal disease may also increase in incidenceand severity. The chronic nature of dental caries predicts that troops who have deployed initially in anorally fit condition will deteriorate if field oral hygiene is not practiced and if sustaining and maintainingdental care is not provided. Oral and maxillofacial injuries from both battle and nonbattle cause an increasein operational settings. All oral infections can advance to life-threatening oropharyngeal fascial spaceinfection or cavernous sinus thrombosis if inappropriately managed.

4-4. Operational Tasks

Operational tasks common to all dental units which must be addressed to accomplish the dental servicemission regardless of the TO and tactical situation, are�

� Understanding situational awareness information. (As the basis for making a decision.)Simply, it is understanding oneself, the enemy, and the terrain or environment and mission.

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� Understanding the operational and political requirements�mission unique requirements.Advising the commander on capabilities, limitations, requirements, resource availability, and readinessstatus of the area of interest.

� Preparing, updating, and maintaining estimates. Assist the commander in decision making.

� Preparing plans and orders. Identify specified and implied tasks to support the plan. (See FM101-5.)

� Conducting training. The dental planner must assess training requirements within hisrespective area of interest. The planner must determine the amount and type of training and requirementsfor evaluating the training and then be responsible for planning and supervising this training within thedental command.

� Performing risk management. The dental planner will integrate risk management into theplanning and execution training and operational missions. (See Appendix J, FM 101-5.)

� Mobilizing during a crisis. All US military units have preexisting plans for use in the event ofmobilization. Mobilization requires extensive and comprehensive planning to ensure that it can beaccomplished in an efficient and timely manner.

� Predeployment activities. Predeployment activities is the first of five deployment phases. TheArmy prepares its units for crisis-action and force-projection missions based on the operational requirements.Dental commanders must conduct necessary deployment and individual and collective training to attain thedesired mission capability in the shortest possible time consistent with the planned deployment. (See FM100-17.)

� Deployment. Consists of five phases. Predeloyment activities being Phase I and discussedabove; and Phase II-movement to the port of embarkation; Phase III-strategic lift; Phase IV theater basereception; and Phase V-theater onward movement which round out the process of deploying soldiers andequipment to carry out the operation. Each of these phases is very important in of themselves. Key to thesuccess of any operation is the sustainment of the units being deployed. Key to the whole process is plan-ning, coordination and execution of the plan.

� Reconstitution and redeployment. At the completion of operational requirements, forces moveback to designated tactical assembly areas. Accountability of equipment and personnel and unit integritymust be a maximum concern during this Phase I of redeployment; repacking and loading containers underUS Customs and US Department of Agriculture supervision. The remaining steps are: Phase II-movementto redeployment assembly areas; Phase III-movement to port of embarkation; Phase IV-strategic lift; PhaseV-reception at port of debarkation; and Phase VI-onward movement from port of debarkation. Completediscussion of each of these phases is found in FM 100-17.

These tasks in themselves do not constitute a mission essential task list (METL), but should be considered inMETL development. These general tasks are the basis for the subsequent sections in this chapter.

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4-5. Standing Operating Procedures

a. General. A SOP is a list of standing procedures that are unique to the organization. The SOPwill vary from unit to unit based on mission, guidance from higher headquarters, and other variables. Itfacilitates and expedites operations by simplifying combat orders. Field Manual 101-5 provides generalguidance on SOP. There is no specified format for SOP preparation due to the wide range of commandguidance and variable factors. In some cases, however, higher headquarters may prescribe the format forthe SOP.

b. Dental Unit Standing Operating Procedures. Dental units should have both a CSOP (seeAppendix D) and a TSOP (see Appendix E).

� Clinical standing operating procedure. The need for each DTF within the unit todevelop a CSOP is discussed in Chapter 3 and further explained in Appendix D.

� Tactical standing operating procedure. The TSOP should cover the entire spectrum ofcollective unit operations with focus on those matters pertaining to unit movement, sustainment, andsurvival. The basic reference for the development of a unit TSOP should be the TSOP of the higherheadquarters. (See Appendix E.) The TSOP of the medical company (dental service) should reflect theguidance contained in the TSOP of the parent medical group, the medical brigade, and/or the MEDCOM.

Section II. DENTAL SERVICE SUPPORT PLANNING

4-6. General

Dental service support planning is accomplished at all echelons of medical care within the dental command.Dental commanders� plan for the implementation of guidance provided by higher-level staff dental surgeonsin the overall operation planning process. Field Manuals 8-42, 8-55, and 101-5 provide specific guidanceon the military decision-making process. This process leads to rehearsal and the execution and assessmentof the mission. (Refer to FM 101-5 for a detailed discussion on the development of OPLANs and OPORDsas ready references for all dental planning.)

4-7. Planning Process

The planning process is dynamic because plans must be constantly revised in response to changing situations.The planning process outlined in FM 8-55 is applicable to DSS planning and subsequent operations.

4-8. Types of Plans and Orders

There are five types of military plans�OPLANs (the OPLAN becomes the OPORD when the conditions ofexecution occur and the execution time is determined), the service support plan (SSPLAN), the supporting

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plan, the contingency plan, and the concept plan. The two types of plans most likely to be prepared bydental units are the OPLAN and the SSPLAN. All plans become orders. There are two general classes oforders�administrative and combat.

a. Administration orders cover normal administration operations in garrison or in the field suchas general, specific, and memorandum orders, court-martial orders bulletins, circulars, and othermemoranda.

b. Combat orders deal with the strategic, operational, or tactical operations and their servicesupport, to include CSS. The combat orders most likely to be used by dental units are the OPORD.Combat orders also include a service support order which provides the plan for service support of operationsincluding administrative movements; a movement order (a stand-alone order that facilitates an uncommittedunit�s movement); a warning order (WARNO) (a preliminary notice of an order or action that is to follow);and a fragmentary order which provides timely changes of existing orders to subordinate and supportingcommanders while providing notification to higher and adjacent commands.

4-9. Deputy Commander, Dental Service, Corps Medical Command

The primary responsibilities of the deputy commander, dental services includes developing the overall DSSplan for the command, monitoring dental unit readiness and capability within the command, and providingguidance to dental units subordinate to the command. Field Manuals 8-55 and FM 8-42 provide extensiveinformation on the dental role in the planning process. The first step in the planning process is to preparethe dental estimate of the situation as part of the CHS estimate. Working with the command surgeon, thenext step is to prepare the dental portion of the CHS OPLAN. Finally, working with the corps MEDCOM,the Assistant Chief of Staff for Security, Plans, and Operations will develop the corps MEDCOM OPLAN/OPORD, which in turn provides guidance to subordinate units for preparation of their plans and orders.

4-10. Formats

Generally, formats for most plans and orders follow the recommended examples provided in FMs 8-55, 8-42, and 101-5, unless higher headquarters provides specific guidance on format. Formats should bestandardized within the unit as a matter of TSOP. Time and METT-TC may dictate expediency and theneed for an improvised format. In all cases, however, the basic principles for preparing a plan/order shouldbe applied.

Section III. UNIT MOVEMENTS

4-11. General

The principles of CHS (conformity, continuity, control, proximity, flexibility, and mobility) place a premiumon the ability of a unit to move on the battlefield. Dental units deploying from outside the TO require

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proficiency in all means of strategic conveyance. Unit movements and movement by elements within theunit are complex and require detailed planning and coordination as well as effective training. Proceduresfor unit movements must be detailed in the unit TSOP and unit movement plans. These procedures aresupplemented with a formal movement order for each operation. Movements within the TO can beclassified as either tactical or administrative.

4-12. Strategic Movements

Strategic mobility may involve movement by air, sea, rail, or land. Each type of movement requires specialskills and training. The unit�s field executive officer is generally designated as the unit movement officerand must be school trained and certified along with a number of enlisted personnel. Training must beaccomplished prior to notification. Unit movement personnel supervise the loading of the unit�s vehiclesand equipment as directed by the loadmaster of the particular conveyance. Strategic movements by dentalunits are usually a part of a larger effort by the medical group, medical brigade, or MEDCOM and will beprimarily directed by those headquarters. Dental units should prepare individual movement plans andorders consistent with the guidance provided by the higher headquarters.

4-13. Movements Within the Theater

A tactical road march is the most likely means of movement, but units must be trained in other methods,based on the situations they are likely to encounter. With limited organic transportation assets, detailed andprioritized load plans are essential to quickly establish dental services upon arrival at the planned destination.Dental units and their subordinate elements may well be expected to conduct airmobile operations usingsling-load techniques that may require special training and certification. A tactical airlift of equipment isanticipated as the depth of the battlefield increases. An increased reliance on innovative methods ofmovement is also foreseen in the future, placing more emphasis on lightweight equipment, well-trained andconditioned soldiers, and flexibility on the part of the commander. A commander will train and certify hisunit in preparation for all movement options.

4-14. Convoy Operations

The most likely transportation platforms for dental units will be by organic vehicles. Tactical road marchesare demanding operations and tactical road marches may be conducted over all types of terrain, to includeunimproved roads and cross-country. Environmental conditions and the enemy threat, particularly NBCand air, are vital considerations. (See FM 8-10-1.)

4-15. Unit Movement Plans

Unit movement plans contain up-to-date logistical data summarizing transportation requirements, priorities,and limiting factors to the unit�s movement. The contents of the plan may vary depending on the mission ofthe unit and guidance from higher headquarters. As a minimum, the unit movement plan should contain thefollowing:

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a. A detailed listing of personal baggage, organizational equipment, and expendable andnonexpendable supplies in a shipping configuration.

b. The officer in charge of movement implements the TSOP (see Appendix E) for the movementstaff, advance parties, quartering parties, and rear detachments.

c. Procedures to be followed at the beginning of the movement, en route, and at the destination.

d. Unit loading plans.

4-16. Procedures for Unit Movement

The unit TSOP should include such unit movement details as�

� Composition of march units.

� Combat health support requirements.

� Duties of the advance party, reconnaissance element, and rear party.

� Control and communication methods.

� Convoy security.

� March speed.

� Accident reporting procedures.

� Refueling, maintenance, and field feeding procedures.

� Personnel and equipment load of organic vehicles.

� Conduct of periodic rehearsals.

� Reaction to enemy action.

� Procedures at the destination.

The TSOP must be flexible enough to allow accommodation of the current mission, yet thorough enough toallow efficient and predictable action.

4-17. Unit Load Plans

Unit load plans include all individually prepared documents which, taken together, present in detail allinstructions for the movement of personnel and the loading of equipment. Load plans are prepared for each

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of the unit�s organic vehicles and should be consistent with the sectional organization of the unit to allowflexibility and maintain sectional integrity. They should also be individually configured to expedite thesetup of the unit/section facilities. Load plans are prepared according to the unit TSOP or the commander�sguidance. A separate set of load plans should be maintained for air movements involving special handling.Load plans are the responsibility of the unit movement officer and should be maintained by the unit, thesection, and the individual responsible for each vehicle.

Section IV. PROVISION OF DENTAL SERVICES

4-18. General

The single most important function of DSS units is, of course, to provide dental care. The dental serviceunits will provide this service within its AOR in a manner which best accomplishes this overall mission.Field dentistry is covered extensively in Chapter 3. This chapter looks at dentistry and associated dentalservices at an operational level.

4-19. Patient Population

a. Eligible Beneficiaries. Army medical and dental care is provided to US Army forces deployedin the TO and members of the sister Services. This care, as determined by the appropriate authority (basedon the recommendation of the command surgeon and in conjunction with legal authority), may also beprovided to other eligible beneficiaries (depending upon the type of operation). This list could include�

� Host nation indigenous populations.

� Nongovernment organizations.

� Private volunteer organizations.

� United Nations forces and personnel.

� Civilian employees.

� Contract employees.

� United States service members and allied forces.

� Refugees and displaced persons.

Priority of treatment is based on the patient�s medical/dental condition, availability of resources, negotiatedagreements, and applicable laws and conventions. Army Regulation 40-3 provides guidance on eligibilityfor care; however, other guidance may be provided in the OPORD of higher headquarters.

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b. Geneva Conventions Provision for Prisoners of War. The Geneva Conventions require thathealth care be given to friend and foe (for example, EPW) alike without distinction. Therefore, dental unitsmay be charged with the mission of providing emergency dental treatment to EPW. (Refer to FM 8-10 foradditional information.)

c. Stability Operations and Support Operations. Dental operations are generally associated withnation assistance and other aspects within the range of military operations that are covered extensively inChapter 7. However, there will be times in more conventional conflicts when dental civic action operationsmay be called for, particularly as part of overall postconflict civil affairs operations. (See FM 8-42 foradditional information on these subjects.)

4-20. Dental Service-Related Missions

Dental units will participate in other nondental missions that support the overall CHS mission.

a. Additional Wartime Role. The most important of these adjunctive missions is known as theadditional wartime role, which deals primarily with the augmentation of medical assets during mass casualtyoperations. Chapter 8 addresses the additional wartime role in detail, both individual and unit level.

b. Veterinary Support. Government-owned animals, particularly extremely valuable militaryworking dogs (MWD), may be used extensively in a TO. The MWD are subject to dental injuries,particularly fractured teeth. Dental officers may be called upon to assist the veterinary staff in the treatmentof these injuries and restoration of the involved teeth.

Section V. SUSTAINMENT OF DENTAL OPERATIONS

4-21. General

Sustainment of dental operations is a critical aspect of mission accomplishment. The principles of CHS(mentioned in paragraph 4-11) place a premium on mobility and flexibility, thus requiring careful attentionto logistical concerns to ensure they do not encumber the mission. Sustainment issues generally fall into thecategory of service support including�

� Personnel service support.

� Combat health support, to include CHL operations.

� Morale and welfare activities.

� Chaplain services.

� Postal services.

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� Unit administration.

� Classes of supply, I through X.

� Finance services.

� Legal services.

� Maintenance.

Relative to their size and capability, dental operations consume power, fuel, water, and Classes I-X suppliesand equipment. Careful planning for these products is a must for sustainment. Chapter 10 discusses serviceand support in detail; however, some general considerations for planning purposes are addressed here.

4-22. Sustainment Planning

Sustainment planning must be incorporated in the unit�s OPLAN or OPORD. Sustainment issues areusually included in a service support annex to the basic plan or order, or may be included in paragraph 4,Service Support, of the basic plan. Sustainment issues should also be addressed in the unit�s TSOP, and forthose items that pertain to DTF operations, in the CSOP.

4-23. Support Arrangements

Dental units have varying degrees of sustainment self-sufficiency; however, all depend on other units forsome of their support.

a. Support Arrangements. Support arrangements are generally directed in the OPLAN andOPORD of the higher headquarters. They are generally in the form of an attachment specified by the parentunit. Other variations include DS from the headquarters company of the parent C2 organization, collocationwith informal support arrangements, and, less frequently, as part of a consolidation into a composite CHStask force. In addition to sustainment issues, survival issues, such as collective security, must be addressedwith the host unit. Survival issues are discussed in Section VI of this chapter.

b. Types of Supporting Units. Combat health support units providing medical or dental treatmentare the most desirable units for attachment of dental units or their subordinate elements. The dental unit isdependent upon�

� Appropriate elements of the theater MEDCOM, the corps MEDCOM, Medical group,and the medical brigade for CHS, administrative, technical, and logistic support.

� Appropriate elements of the corps for legal, finance, personnel and administrativeservices, food service, water, resupply of nonmedical classes of supplies, supplemental transportationsupport, religious services, laundry, bath, and clothing exchange services, graves registration, and securityof treated EPW.

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When treatment teams are further attached, these teams will be dependent upon appropriate elements of thedivision for legal, finance, personnel, and administrative services; food service and water; Class VIIIsupplies and resupply of nonmedical classes of supplies; supplemental transportation support; maintenancefor vehicles, generators, and communications equipment; religious services; CHS, patient evacuation;laundry, bath, and clothing exchange services; patient decontamination; graves registration; and security oftreated EPW.

Section VI. SURVIVAL IN THE COMBAT ENVIRONMENT

4-24. General

The threat to survival is broad-based and affects a unit, both individually and collectively. The threat can bedivided into general categories�the environment itself, enemy action, and the concomitant stressesgenerated.

4-25. Threat from Enemy or Others

The threat to dental units includes�

� Deliberate attack on dental units or collateral damage from attacks upon legitimate targets.

� Direct and indirect ground fires.

� Air attack by fixed- and rotary-wing aircraft and guided missiles.

� Special operations.

� Attacks by irregular combatants (terrorists and insurgents).

� Weapons of mass destruction.

� Accidental nuclear release.

� Biological warfare.

� Chemical warfare.

� High explosives.

� Toxic chemicals.

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Munitions may include conventional ammunition, incendiary munitions, and NBC. Dental units are anunlikely direct target of enemy action; however, they are still at risk based on their location in relation tomore lucrative targets. Dental units are perhaps at greatest risk when moving, particularly alongmain supply routes (MSR). Dental personnel are armed only with defensive weapons. They have alimited capability for active defense and must rely on passive defense measures and collective securityarrangements.

a. Nuclear, Biological, and Chemical Threat. Dental operations in an NBC threat area poseproblems for unit survival and patient care operations. Chapter 9 deals specifically with dental operations inan NBC environment. (See also FM 8-10-7.)

b. Conventional Threat. Dental unit reaction to a conventional threat relies primarily onindividual and collective passive security measures such as field fortifications and barriers, as well asvigilance and access to intelligence and warning systems.

c. Tactical Standing Operating Procedure. Personnel and collective unit defensive action toenemy actions should be addressed in the TSOP and drilled as a matter of course during exercises and actualoperations.

4-26. The Effects of the Law of Land Warfare on Dental Service Support

The Geneva Convention for the Amelioration of the Condition of the Wounded and Sick (GWS) offersprotection to units and personnel involved in providing dental services, but with certain obligations. TheConvention is very detailed and contains many provisions that pertain directly to the CHS mission. In-depthdiscussions of the provisions pertaining to CHS operations are provided in FMs 8-10 and 27-10 and aregood sources of information for the effects of the Laws of Land Warfare on CHS. Only the majorapplications to dental units are discussed in this section.

a. Protection of Dental Patients. Dental patients fall into the category of wounded and sick andare protected under the provisions of the GWS.

b. Protection and Identification of Dental Personnel. The GWS provide special protection formedical/dental personnel exclusively engaged in the providing of CHS. This includes both protection fromintentional attack and the requirement for special handling in the form of retained person status in case ofcapture. In order for dental personnel to be afforded this protection, they must be identifiable as medicalpersonnel by the enemy and they must be �exclusively engaged in the search for, or the collection,transport, and treatment of the wounded or sick or in the prevention of disease, and staff exclusivelyengaged in the administration of medical units and establishments.� For identification purposes,identification is facilitated by medical personnel wearing an armband bearing the distinctive emblem (a redcross on a white background), or by their employment in a medical unit, establishment, or vehicles thatdisplays the distinctive emblem.

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� The GWS does not itself prohibit the use of medical/dental personnel in perimeterdefense of nonmedical units such as unit trains, logistics areas, or base clusters under overall securitydefense plans, but the policy of the US Army is that protected personnel will not be used for thispurpose.

� Adherence to this policy should avoid any issues regarding their status under the GWSdue to a temporary change in their role from noncombatant to combatant. Medical personnel may guardtheir own unit without any concurrent loss of their protected status.

This paragraph implements STANAG 2931

c. Protection and Identification of Dental Treatment Facilities. Dental facilities are also protectedfrom intentional attack if they are identifiable as such by an enemy in a combat environment. Normally thisis facilitated by dental units or establishments flying a white flag with the distinctive emblem and bymarking buildings with the distinctive emblem on a white background. (It should be noted, however, thatthe camouflage of a medical/dental facility is authorized when the lack of camouflage might compromise thetactical operation. If the failure to camouflage endangers or compromises the tactical operations, thecamouflage of medical/dental facilities may be ordered by a NATO commander of at least brigade level orequivalent. Such an order is to be temporary and local in nature and is countermanded as soon ascircumstances permit.) Use of the red cross symbol on facilities highlights the status of the facility;however, it is not mandatory. While use of camouflage or other concealment does not in itself result in lossof protected status, it is less likely that the enemy will be aware of the protected status of the unit. The useof camouflage for dental units, therefore, becomes a tactical decision, generally made by the major tacticalcommander in the area.

4-27. Rear Area Operations

a. Rear operations are actions, including area damage control, taken by units, singly, or in aconcerted effort, to secure and sustain the force, neutralize or defeat enemy operations in the rear area, andensure freedom of action in deep and close operations.

b. Combat health support units are established within base clusters to afford them the protectionoffered by the other combat, CS, and CSS forces. Combat health support units are limited by the provisionsof the Geneva Conventions in responding to enemy action. (Refer to Appendix A, FM 8-10 for additionalinformation on self-defense and the defense of patients.)

c. Dental units must be prepared to assist medical treatment elements in mass casualty situationsthat may arise in the rear area. Thorough planning, effective communications, and training and rehearsal ofthese types of operations are required if they are to be successfully executed.

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Section VII. RECONSTITUTION AND REDEPLOYMENT PHASE OFDENTAL OPERATIONS

4-28. General

Upon mission completion, dental units must be able to rapidly recover and redeploy from the TO, orcontinue to support the overall mission. There are four major areas to be considered in the recovery phaseof operations�recovery, reconstitution, redeployment, and documentation. Traditionally, the recoveryphase of operations has not received the same degree of emphasis as other operational tasks; however, theneed for rapid reaction and flexibility on the modern battlefield demands otherwise. Upon completion ofany operation within a TO, there is a natural tendency for letdown and a corresponding drop in the sense ofurgency perceived by the soldiers of the unit. Successful recovery presents the greatest challenge to thecommander�s ability and is a major test of the unit�s level of discipline. Those tasks associated withrecovery must be clearly delineated in the TSOP and trained on a regular basis.

4-29. Redeployment

Redeployment applies at the tactical, operational, and strategic levels. Redeployment is fully explained inFM 100-17. It is important to note that redeployment does not signal termination of the cycle of operationaltasks for any theater units. Rather, it signals the start of a new cycle as the commander initiates planning forthe next operation.

4-30. Reconstitution

Reconstitution is the basis for the treatment team concept. It is the ability to maintain continuously, insufficient measure, the capability to create additional forces beyond those of the base force. Reconstitutionis also the process of creating additional forces to deter an emerging global threat from competing militarilywith the US. In the case of dental units, a treatment team consists of a dentist and a dental assistant. Withrespect to all dental units, reconstitution will generally consist of cross-leveling or replacing personnel,supplies, and equipment.

4-31. Documentation

Documentation in the form of an after-action report (AAR) is important. The AAR serves not only as abasis for immediate reconstitution, but also acts as a historical reference and a basis for future planning. AnAAR should be accomplished after the termination of each mission and again, in greater detail, uponcompletion of the overall operation. A greater emphasis is being placed on the collection of lessons learned;therefore, their documentation in the AAR simplifies response to calls from outside agencies. The formatfor the AAR is often specified in the TSOP of higher headquarters, but should be modified to accommodatedental concerns. When no prescribed format is directed by higher headquarters, dental units should developtheir own as a matter of TSOP.

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CHAPTER 5

COMMAND, CONTROL, AND COMMUNICATIONS


5-1. General

In Chapter 4 (paragraph 4-4), ten operational tasks were listed that need to be performed by dental units toaccomplish the overall mission of providing dental service. In this chapter, C2 is yet another task that mustbe successfully accomplished. It is addressed separately here because it is an inherent part of each of thepreviously discussed tasks, as well as a means of coordinating all of the tasks toward the single objective ofmission accomplishment.

5-2. Concept of Command and Control

a. Title 10 of the US Code directs dental officers to be organized into dental units commanded bydental officers. However, some means must be provided for coordinating the overall DSS effort with thosedental assets not assigned directly to dental units, as well as among the dental units themselves. It isimportant, therefore, to understand the various dental commands and technical supervision chains alongwith the communication systems that support them.

b. Command and control of dental personnel assigned to an ASMB is relatively straight-forward;however, overall control of dental services in the CZ and within the entire theater is complicated becauseapproximately one-third of the dental officers within the CZ do not fall under direct dental C2. It isimperative that dental resources in a theater synchronize their activities through available channels toprovide a coordinated system of dental services. In many cases, this will call for a flexible and innovativeapplication of normal C2 doctrine. It also requires a great deal of cooperation between all the separatedental elements in the theater.

Section II. COMMAND AND CONTROL

5-3. General

According to FM 101-5, command is the authority a commander lawfully exercises over subordinates byvirtue of rank or assignment. Inherent in command is the responsibility for the soldiers� health, welfare,morale, discipline, and training, as well as authority under the Uniform Code of Military Justice and ethicalresponsibilities under the Law of Land Warfare. Command also includes the responsibility and authorityfor planning, employing, organizing, directing, coordinating, controlling, and maintaining the unit�sresources in a ready condition. The latter processes can be thought of collectively as control. They areoften delegated, in part, to members of the staff. In the case of commands with staff dental surgeons andsubordinate dental units, delegation of some degree of control over dental operations by the nondental com-mander to his dental surgeon is the most effective means of providing coordinated dental services. Commandresponsibility and authority are established through various standard relationships described in FM 101-5.

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5-4. Technical Supervision

Field Manual 101-5 states that when the technical or professional nature of certain activities requires aspecial relationship, command responsibility and authority may rest with a commander outside the normalorganizational chain of command. With respect to dental operations, technical supervision applies only toprofessional matters and aspects of the dental portion of the overall CHS plan. Technical supervision doesnot usurp command prerogative with regard to employment and operational control; however, it can greatlyinfluence conduct of operations at subordinate levels. Technical supervision guidance is usually in the formof a policies and/or command directives. Dental commanders exercise technical supervision over theirsubordinates as part of their command authority. At higher levels, the corps MEDCOM deputy commanderfor dental services exercises technical supervision. This individual, in addition to providing technicalsupervision, will interface with higher headquarters to include joint, allied, coalition, and host-nation dentalservices. The theater MEDCOM dental surgeon exercises technical supervision over all dental assets in thetheater.

5-5. Command and Technical Supervision Chains

Figure 5-1 illustrates the dental command and technical control relationships in a five-divisional notionalcorps model. Though notional and based strictly on basis of allocation (BOA) for the units depicted, it is afairly standard laydown. Combat health support organization in EAC is far more variable; however, thebasic dental command and technical supervision relationships would be fairly similar. The continuous,solid lines in the figure represent the notional command chain overall, and the wide lines highlight the puredental portion of the command chain. The broken lines represent the dental technical supervision chainbased on the principles discussed in paragraph 5-5. In many cases, the technical supervision chain crossesover the standard command chain, highlighting the difficult challenge posed to the senior dental surgeon inorchestrating a coordinated dental service program.

5-6. Interim Relationships

Dental resources are a scarce asset within the TO. It is, therefore, essential that they be employed in amanner that maximizes their capabilities.

a. Command. In the absence of a dental C2 headquarters, dental assets are assigned to the seniormedical C2 headquarters. If the headquarters does not have a dental surgeon assigned, the commander ofthe dental company/detachment/team also serves as the command dental surgeon. In addition, the dentalcompany/detachment/team commander serves as the medical brigade dental surgeon. In this arrangementas the command dental surgeon, he provides technical supervision and advice on the delivery of dentalsupport, and as the commander, he exerts control over the employment of the dental assets commandwide.

b. Technical Supervision. If the senior medical headquarters has a dental surgeon assigned, hehas staff responsibility (to include technical supervision) over the dental assets assigned to the command.However, he does not have a command relationship with these units. To facilitate dental care delivery, thisstaff officer must ensure that the dental support effort is synchronized and uses the available dental assets

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efficiently. Because of his position, the dental surgeon has the ability to identify and analyze the dentalsupport needs of the entire command, rather than only a specific dental element�s AO. To enhance themedical headquarters commander�s ability to provide dental services throughout his command, the dentalstaff surgeon may reach an understanding with the medical headquarters commander to facilitate thisprocess. This agreement may permit the dental surgeon, in the name and authority of the medicalheadquarters commander, to dictate and coordinate the employment of the dental assets within that command.

Figure 5-1. Corps dental organization.

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5-7. Theater Army Dental Surgeon

The theater MEDCOM dental surgeon also serves as the Air Standardization Coordinating Committee. Inthis vital role, he is the primary interface with the CONUS base for transfer of dental information. Inaddition to establishing overall theater dental policy, he is also the primary Army consultant to the unifiedcommand surgeon on joint service dental matters. In many instances, a formal MEDCOM is not present inthe theater. It is important, however, that there be effective dental representation on the Army surgeon�sstaff, or in any provisional MEDCOM that is formed, regardless of the size of the theater. Again, thesenior dental officer (by position) assumes this role.

Section III. COMMUNICATIONS

5-8. General

Effective C2 depends on a reliable system of communications for the transfer of information. Com-munication equipment organic to CHS units is relatively limited. The CHS system, therefore, depends onDS and general support signal corps services. Combat health support commanders must understand thetotal Army communications system to effectively communicate on the battlefield and with the CONUS base.Field Manual 24-1 provides guidance on basic battlefield communications systems. The CHS commandersmust incorporate support available from signal support systems into their overall com-munications plan.

5-9. External Communications Support

Dental units are dependent on other units for varying degrees of communications support. This is particularlytrue for detached dental elements that have no capability other than a single field phone instrument, yet muststill maintain contact with their unit headquarters. The two most likely possibilities for communicationssupport are described below.

a. Supporting Medical Unit. The supporting unit for dental units and their elements is a hospital.Army hospitals have radio capability with their parent headquarters, and in most cases, with other hospitals.Additionally, they are equipped with a switchboard into which the dental element can link its field telephone.

b. Signal Corps Units. Dental units are unlikely to have a direct relationship with signal corpsunits in the area. However, they will be able to access a network system, either through their supportingunit or through direct wire linkage to the signal node. Landline telephone networks established by signalcorps units are of particular benefit to dental units.

5-10. Alternate Communications Means

Alternative means of communication are available in addition to radio nets and voice telephone. Mostinvolve the passage of hard-copy data, either handwritten or machine transmitted. The advantage of hard

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copy is that it is addressed specifically to the recipient, reducing the possibility of radio operators failing topass on relayed information. It is also more appropriate for the transfer of voluminous statistical data andreports. Listed below are some possible alternatives to radio and voice telephone communications.

a. Teletype. If adjacent units have teletype capability, dental elements may be able to use thatequipment to send the addressed message and rely on the receiver to deliver the message as appropriate.

b. Facsimile. Facsimile (FAX) machines are becoming common on the battlefield. Dentalelements with access to units equipped with FAX machines may be able to establish a support arrangementsimilar to that for the teletype systems described above.

c. Message Center Distribution. The MEDCOM and medical brigades/medical groups may havean established message center distribution network that can be used by assigned dental units.

d. Unit Courier. When all else fails, dental units may have to rely on an internal unit couriersystem, using organic vehicles. An effective method is to couple message traffic with scheduled andunscheduled supply distribution runs.

Section IV. COMMUNICATION OF DENTAL INFORMATION

5-11. General

The extremely limited capability for voice communications organic to dental units is offset somewhat by thelimited amount of information that needs to be transmitted in real time. Most dental information isadaptable to �roll-up� and hard-copy transmission on a periodic basis. Dental commanders and staff dentalsurgeons should identify that information which must be transmitted and the appropriate channel fortransmission.

5-12. Command and Staff Communications Channels

Command and staff communications channels are a means of passing or communicating orders, instructions,advice, recommendations, and information within a headquarters and from one headquarters to another.

a. Command Channel. This channel is the direct, official link between headquarters andcommanders. All orders and instructions to subordinate units pass through this channel. Within the dentalunits, instructions from the dental commander to his subordinate units or elements pass through commandchannels. Most command channel information relates to the immediate tactical situation and requires rapidtransmission and dissemination.

b. Staff Channel. This channel is the staff-to-staff link between headquarters. Within dentalunits, the staff channel deals primarily with day-to-day administration and support activities.

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c. Technical Channel. Commanders and staff use this channel to send technical instructionsbetween commands. Unlike the command channel and the staff channel, there is generally no dedicatedtechnical communications channel. This is particularly true for dental technical information. However, theoverall dental care system relies heavily on technical channels for dissemination of patient treatment policyand other professional guidance.

5-13. Types of Dental Information

Given their limited communications capability, dental commanders and staff dental surgeons must choosecarefully which information must be passed and which mode of transmission to use. Described below arevarious items of information pertinent to dental units and the probable mode of transmission. This descriptionis not absolute and is open to modification to suit a particular situation; however, it does provide a goodbasis for establishing an effective dental information network.

a. Command Information. Command information is disseminated through command channels todental units and their subordinate elements, if dispersed. The command channel generally consists of asecure radio net that is used to transfer immediate information concerning the tactical situation. Commandinformation that is less time sensitive is usually transferred by hard copy or field telephone, if appropriate.Examples of command information are orders, directives, and NBC reports. Routine dental serviceoperational matters generally are not transmitted over command channels.

b. Routine Information. The majority of dental information constitutes routine business and ispassed through staff channels, both within the dental battalion and from the battalion to its higherheadquarters. Most data-type information and standard reports passed through staff channels are transmittedby wire, FAX, or by courier, if necessary. Bulk information is generally passed by courier. The primarymeans of voice transmission is by field telephone and available landline networks. Generally, dental unitsdo not pass routine staff information through radio networks; however, in certain situations some units mayrequire passage of formatted daily status reports by radio. For convenience, a TSOP generally prescribesformats for reports and information required on a regular basis by higher headquarters. Staff channelinformation pertinent to dental units covers the full spectrum of administration, support, and clinicaloperation matters including�

� Personnel actions.

� Combat health logistics resupply and stockage levels.

� Workload reporting.

� Clinic status reports.

� Medical equipment maintenance.

c. Technical Information. Dental technical information generally addresses professional mattersand patient treatment policy and is issued in the form of written policies and/or directives. Dental technical

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information is generally not time sensitive and is passed in hard copy. There may be rare instances,however, when information, such as drug or materiel safety alerts, requires URGENT priority for wiretransmission. An important link in the dental technical channel is with the CONUS sustaining base throughthe Office of the Assistant Surgeon General for Dental Services. The MEDCOM dental surgeon or thesenior dental surgeon in the theater must establish this link. This is done either through the mail for bulkinformation, or using strategic communications capability, if accessible, for more time-sensitive information.

5-14. Patient Treatment Data

Capture of patient treatment data is necessary for planning current DSS and distribution of resources. Italso serves as a basis for future research and analysis of dental force structure requirements. Patienttreatment information must be recorded, consolidated, and forwarded through the appropriate communi-cations chain for further analysis and consolidation at each level.

a. Patient Treatment Data Chain. Patient treatment information generated by the medicalbattalion (dental service) commander, hospitals, and the ASMB assigned to the medical brigade is forwardedthrough normal staff channels, to the corps MEDCOM. Here the deputy brigade/group commander (dentalservices) consolidates the information and forwards it to either the theater MEDCOM or CONUS.

b. Dental Status Report. Figure 5-2 is a proposed format for a dental status report to beforwarded through the dental information chain, as required. At lower levels, it is forwarded daily byDTFs to their parent unit, which, in turn, consolidates the input for forwarding to higher levels.Consolidating and forwarding from the medical group/brigade may be on a less frequent basis, but shouldbe timely enough to allow senior staff dental surgeons to react to developing trends and situational changes.This status report is a consolidation of key items of information for planning purposes; for additionalinformation, refer to Chapter 3.

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SAMPLE FORMAT

DAILY DENTAL UNIT STATUS REPORT

UNIT DATE (DAY/MONTH/YEAR)

LOCATION _________________________________

DESCRIPTION ARMY AF NM OTHER

DENTAL EMERGENCIES

DISEASE AND NONBATTLE INJURY

BATTLE INJURY

DENTAL EMERGENCY FOLLOW-UP

ESSENTIAL CARE

POSTMORTEM EXAMINATIONS

PREVENTIVE DENTISTRY

DENTAL PROPHYLAXIS

OTHER PREVENTIVE SERVICES

ADMINISTRATION (REMARKS)

PERSONNEL __________________________________________________________________________

______________________________________________________________________________________

EQUIPMENT ___________________________________________________________________________

______________________________________________________________________________________

SUPPLIES _____________________________________________________________________________

______________________________________________________________________________________

FACILITIES ____________________________________________________________________________

______________________________________________________________________________________

OTHER _______________________________________________________________________________

______________________________________________________________________________________

SIGNATURE BLOCK

LEGEND:

AF AIR FORCENM NONMILITARY

Figure 5-2. Daily Dental Unit Status Report.

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CHAPTER 6

EMPLOYMENT OF THE MEDICAL BATTALION(DENTAL SERVICE)

6-1. General

The medical battalion (dental service) is the only C2 dental unit in the TO. The units assigned to themedical battalion (dental service) will provide field dental clinics in the corps and EAC. It deploys forwardtreatment teams to the division and brigade areas in the CZ with the capability to administer sustaining andemergency care. The level of care will be determined by the tactical situation. These teams augment andreinforce medical units with organic dental assets.

6-2. Medical Battalion (Dental Service)

The medical battalion (dental service) is generally subordinate to the medical brigade/medical group of thecorps MEDCOM; however, it could be directly assigned to the corps MEDCOM and theater MEDCOM.The number of medical companies (dental service) and medical detachments (dental service) assigned to themedical battalions (dental service) employed depends on the density of troop population to be supported, thesize of the geographic area to be served, and the Army�s fielding plans. This company has a BOA of 1 per20,000 troops supported if collocated with a hospital and an ASMB; otherwise, the BOA is 1 per 24,000troops supported. There may be situations where troop concentrations exceed this BOA, such as inmarshalling areas.

6-3. Medical Detachment (Dental Service)

The medical detachment (dental service) provides operational dental care consisting of emergency andessential dental care on an area support basis within a TO and further provides far forward emergencydental care, as required. This unit may be assigned to the theater MEDCOM, corps MEDCOM, or corpsmedical brigade/group. Within the area support modular design of CHS, the support squad is comprised ofone Dental Corps officer, a dental specialist, an x-ray specialist, and a medical laboratory specialist. Thesquad is organic to the medical companies of separate brigades, groups, divisions, SFG, and ASMC in thecorps and COMMZ. The dental officer will receive additional training (see DA PAM 40-13.) and willprovide additional treatment capabilities to the clearing station during peak patient loads (mass casualties).

6-4. Phased Employment of Dental Services

Current capability based on TOE gives dental units, individually and collectively, the flexibility andadaptability to provide dental support at all levels of warfare from the initial stages of the conflict untilhostilities cease and US presence is terminated. Medical casualties are a function of combat activity andDNBI; however, dental casualties are principally a function of time. If a high state of dental readiness isassumed for troops prior to deployment, it follows that the requirements for DSS units in the theater willincrease as the theater matures. Figure 6-1 illustrates the increase in dental requirements over time basedon past experience.

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Figure 6-1. Increase in dental requirements over time, based on past experience.

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CHAPTER 7

DENTAL SUPPORT IN STABILITY OPERATIONSAND SUPPORT OPERATIONS


7-1. General

a. Dental support in stability operations and support operations range from the traditional supportfor deployed US forces, to establishing and/or augmenting dental programs in nation assistance, humani-tarian, and civic assistance operations. Dental support in domestic support operations is often limited interms of manpower, equipment, and supply. Stability operations and support operations have emerged asan area of high probability for future involvement of the US military. These types of operations encompassa broad spectrum of activities that require a great deal of flexibility and innovation on the part of thoseinvolved.

b. The following overview is a brief discussion of stability operations and support operations andDSS for these operations; however, a more complete understanding is required in planning and executingstability operations and support operations. For additional information on stability operations and supportoperations, refer to FM 8-42.

7-2. Overview

a. Definition. Stability operations and support operations are political-military environments ofpeace and conflict. They frequently involve protracted struggles of competing principles and ideologies.Stability operations and support operations range from subversion to the use of Armed Forces. They areinitiated by a combination of means: employing political, economic, informational, and military instruments.Stability operations and support operations are often localized, but contain regional and global securityimplications.

b. Imperatives. The listed imperatives apply to all operators in the stability operations andsupport operations environment including CHS. (Refer to FM 8-42 for an in-depth discussion concerningthis subject.)

Section II. DENTAL ROLE IN STABILITY OPERATIONSAND SUPPORT OPERATIONS

7-3. General

Dental support assets have the potential to be important contributors during stability operations and supportoperations. While their primary role is to support US, allied, coalition, and host-nation forces, they canalso contribute by participating in dental-related civil affairs operations. Dental support will contribute to

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the broad spectrum of programs within stability operations and support operations, ranging from conductingsmall self-help dental programs in undeveloped rural areas to assisting the host nation�s dental care systeminfrastructure within metropolitan areas. As with other CHS, the effectiveness of dental support is dependenton the mission. Dental support efficiency is closely related to the nature of the stability operations andsupport operations. (See FM 8-42 for specific details on stability operations and support operations.)The following is a partial list of activities and programs for which dental assets could be used:

� Provide dental treatment to members of the local population.

� Conduct oral hygiene classes and provide hygiene treatment in local communities.

� Assist in the establishment of community dental health programs.

� Assist in the development and/or establishment of a host-nation military dental health caresystem.

� Assist in the training of local dental care providers.

� Provide consultation and assistance on host-nation dental health care programs (for example,designing and administering a survey to determine the level of oral health of a population).

For dental support programs to be successful, certain guidelines which parallel the stability operations andsupport operations imperatives must be followed.

a. When working within the host nation�s medical infrastructure, the US dental personnel mustcoordinate with the host-nation dental system from the local to the national level to ensure unity of effort.They must be mindful not to introduce dental programs that cannot be supported by the host nation�sinfrastructure once the stability operation and support operation is completed.

b. Dental programs should be in concert with the political objectives of the country. They shouldbe carefully coordinated with other governmental agencies through the command surgeon.

c. All US dental support activities should be directed toward long-term benefits for the supportedpopulation and should not exceed the capability of the host nation to continue the service once US forceshave departed.

7-4. Dental Support Planning for Stability Operations and Support Operations

Dental staff participation should begin early in the planning of CHS for stability operations and supportoperations. Chapter 4 addresses planning and recommended formats for estimates, plans, and orders.These also apply to stability operations and support operations. A dental-specific stability operations andsupport operations and medical mission reconnaissance checklist is a valuable planning aid. The exampleshown in FM 8-42 could be adapted to fit dental requirements.

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CHAPTER 8

ADDITIONAL WARTIME ROLES

8-1. General

The additional wartime role for dental personnel is to augment the MTF with additional combat casualtycare capability. This is particularly true during mass casualty operations. The dentist may augment thephysicians in mass casualty situations, from assisting in surgery, to managing soft tissue wounds, to triageof patients. While the focus on dental additional wartime roles has generally been at the individual level,collective use of the dental unit or its subordinate elements may also be appropriate.

8-2. Training Requirements

In recognition of the additional wartime role mission, the Chief, US Army Dental Corps, has established aformal policy outlining training requirements in this area. These annual training requirements, basedprimarily on those outlined in Department of the Army Pamphlet (DA Pam) 40-13, are mandatory for alldental officers in the Army Dental Care System. A written record of wartime ATM training is maintainedin the officer�s credentials file and may be credited toward annual continuing health education requirements.Current training requirements address the following general subject areas:

� Forensic dental identification.

� Treatment of maxillofacial injuries.

� Management of soft tissue wounds.

� Operating room procedures.

� Management of NBC casualties.

� Treatment of orthopedic injuries.

� Cardiopulmonary resuscitation recertification.

� Initial burn treatment.

� Intravenous techniques.

� Intubation.

� Infection control and sterile technique.

� Medical triage.

� Psychological care.

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8-3. Dental Operations Employment Options

Execution of the additional wartime role mission is largely dependent on circumstance, but the dental unitmust be prepared for a number of possibilities. There are, however, two general categories of employmentoptions�individual participation and collective unit participation. While the role of the individual dentalofficer has been the focus in the past when discussing additional wartime roles, collective employment ofdental units or their subordinate elements may at times be the option of choice. The probability of casualtiesbeing brought to an available DTF is increased during periods of rear area battle or disaster in the base area.There is also the possibility of casualties from the dental unit itself who will need treatment or stabilizationprior to evacuation. The forward treatment teams, when en route to different locations within the AOR,may encounter casualties along the way; dental officers will respond to the situation.

8-4. Individual Dental Officer Roles

There are a variety of roles that the individual dental officer can perform in support of mass casualtysituations. The role selected is dependent on both the skills of the dental officer and the needs of themedical commander. Possibilities are�

a. Assistant Surgeon. The inherent surgical skills of the dental officer make him well suited foremployment as an assistant surgeon.

b. Triage of Patients. Use of the dental officer to triage patients will free other doctors toincrease the surgical workload capacity.

c. Minimal Treatment Provider. Dental officers can be used as minimal care treatment providers;however, this function should be delegated to medical/dental ancillary personnel.

8-5. Dental Treatment Facilities Additional Use

Dental officers assigned to an MTF, such as a division medical company or a hospital, are most likelyincluded, along with their dental specialists, in the mass casualty plans for that facility. In situations wherea dental unit or one of its larger subordinate elements is collocated with an MTF (perhaps a hospital),collective use of the dental unit in mass casualty situations may be advantageous. When additional treatmentspace is required, use of the adjacent DTF is incorporated into a utilization option.

8-6. Medical Treatment Facility Augmentation Options

There are a number of conceivable options for the use of DTF resources in support of mass casualtyoperations, all of which fit into one of three general categories. The option selected is a matter of agree-ment between DTF and MTF commanders.

a. Individual Augmentation/Manpower Pool. The dental officers essentially augment variousMTF services on an individual basis, and the enlisted soldiers� work out of a manpower pool, primarily to

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support patient transportation. The major disadvantage in this option is that it fails to use the space andequipment available in the DTF. It also fails to use whatever collective skills and training the DTFpersonnel may have.

b. Dental Treatment Facility Responsibility for a Treatment Function. The DTF personnel canestablish a MINIMAL care treatment area within the DTF. This will eliminate congestion in the MTF area,thus freeing the MTF providers for other functions. The most logical of these functions for which the DTFphysical facility and personnel are best suited is treatment of MINIMAL category patients. Minor burns,soft tissue injuries, minor fractures, and sprains are all easily treated in the DTF. This option frees MTFpatient care providers for other areas, expedites RTD of the MINIMAL category patient, and clears theMTF of a large percentage of the patients who can be expected in a mass casualty situation. Successfulemployment of this option requires advanced planning and careful coordination to ensure adequate suppliesare available and that patients are accounted for properly.

c. Combination of the Above. In those cases where a large DTF is collocated with a hospital,sufficient resources may be available to support a combination of both the above options.

8-7. Planning and Coordination

The key to successful use of dental resources in a mass casualty situation is planning and coordination. As amatter of priority, the DTF commander, upon arrival at a site collocated with an MTF, should coordinatewith the MTF commander on a plan for use of the DTF resources in the event the MTF is overwhelmed.Once a plan is established, it should be rehearsed at the earliest opportunity.

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CHAPTER 9

DENTAL OPERATIONS IN A NUCLEAR, BIOLOGICAL,CHEMICAL, OR DIRECTED-ENERGY ENVIRONMENT


9-1. General

The effects of NBC weapons, radiological dispersal devices (RDD), and directed energy (DE) devices onthe battlefield present special challenges in the provision of dental service. The utility of NBC weaponsagainst area targets, as well as their long-range and flexible means of delivery, ideally suit them for useagainst CSS concentrations and MSRs. Generally located within or near these lucrative area targets, dentalunits are at no less risk to NBC weapons than any other unit in the CZ and EAC. Defense against NBCweapons, RDD, and DE sources must be incorporated into the dental unit�s TSOP. Specified individual andcollective tasks must be intensely trained on a regular basis.

9-2. Mission in a Nuclear, Biological, and Chemical Environment

The overall mission of dental units to provide dental services is greatly affected in the aftermath of an NBCattack. First, the unit must survive the attack and rapidly recover from its effects. Second, in the event of masscasualties, the patient care effort must be redirected from dental treatment to the additional wartime role ofaugmenting adjacent MTF as discussed in Chapter 8. Dental services in an NBC environment will generallybe limited to treatment of maxillofacial emergencies requiring immediate attention at the augmented MTF.

9-3. Technical Guidance

There are many sources of technical guidance for dental units on NBC and DE matters. The most specificguidance, however, on preparation for and response to an NBC attack should be contained in the TSOP ofthe parent headquarters. Field Manual 8-10-7 is the basic tactics, techniques, and procedures manualapplicable to dental and other CHS units operating in an NBC environment. Field Manuals 8-9, 8-33, 8-284, and 8-285, and NATO STANAG 2068 provide guidance on patient treatment in the NBC environment.The FM 3-Series provides doctrinal guidance on individual and collective NBC tasks common to all Armyunits. Field Manual 8-50 provides procedures for prevention and treatment of laser injuries.

Section II. NUCLEAR, BIOLOGICAL, CHEMICAL ANDDIRECTED-ENERGY ENVIRONMENTS

9-4. General

The impact of NBC weapons, RDD, and DE devices could result in devastating effects of the involvednations� and their allies� military combat and logistic systems, as well as all of their supporting civilian

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social structures and economies. Chemical warfare weapons and biological agents are easily manufactured;therefore, they may be employed to advantage by Third World nations. Chemical and biological weaponsare most effectively employed against untrained or unprotected targets such as fixed sites (airfields, depots,cities, and ports) which are especially vulnerable. These sites may be targeted as part of the plan to defeatUS force projection. The use of such weapons will potentially produce high casualty rates and materiel lossthrough unprotected exposure. Contamination from NBC weapons and RDD is a major impediment tooperations, even for a well-protected force. Directed energy does not produce contamination, but requiresspecial precautions just the same.

9-5. Nuclear Environment

Nuclear weapons produce three categories of damaging effects�blast, thermal radiation (heat and light),and nuclear radiation (principally, gamma rays and neutron particles). The effects of radiation are spreadby both the detonation blast and the wind, effectively producing widespread areas of contamination.

a. Casualties generated in a nuclear attack will likely suffer concurrent injuries from thecombination effects of blast, thermal burns, and radiation. These casualties fall into three categories:

(1) Irradiated casualty. The irradiated casualty is one who has been exposed to ionizingradiation, but is not contaminated. They are not radioactive and pose no radiation threat to health careproviders. Casualties who have suffered exposure to initial nuclear radiation fit into this category.

(2) Externally contaminated casualty. The externally contaminated casualty has radioactivedust and debris on his clothing, skin, or hair. He presents a �housekeeping� problem. The externallycontaminated casualty should be decontaminated at the earliest time consistent with required care. Lifesavingcare is always rendered before decontamination is accomplished, when necessary. Radioactive contami-nation can be monitored with a radiation detection instrument such as the AN/PDR-27 or AN/VDR-2.Removal of the outer clothing will result in greater than 90 percent decontamination. Soap and water can beused to further reduce the contamination levels. A contaminated patient, or even several contaminatedpatients, is unlikely to present a radiation hazard to attending medical personnel.

(3) Internally contaminated casualty. The internally contaminated casualty is one who hasingested or inhaled radioactive materials; or has had radioactive material injected into the body through anopen wound. The radioactive material continues to irradiate the casualty internally until the materialdecays, is biologically eliminated, or is removed by surgical debridement. Attending health care personnelare shielded, to some degree, by the patient�s body. Inhalation, ingestion, or injection of quantities ofradioactive material sufficient to present a threat to medical care providers is highly unlikely.

b. Dental units operating in a contaminated environment created as a result of residual radiation(fallout) will face three basic problems.

(1) Immersion of the unit area in fallout, causing contamination of shelter, unprotectedsupplies and equipment, vehicles, personnel, and personal equipment.

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(2) Casualties among unit personnel as a result of the detonation or exposure to fallout.

(3) Contamination of supply routes and other areas required for movement.

9-6. Biological Environment

A biological attack (using bomblets, rockets, or spray/vapor dispersal, release of arthropod vectors, andterrorist/insurgent contamination of food and water, frequently without immediate effects on exposedpersonnel) may be difficult to recognize. Biological warfare indicators include�

� An increase in disease incidence or fatality rates.

� Sudden presentation of an exotic disease.

� Other sequential epidemiological events.

9-7. Chemical Environment

Description of the chemical environment is complicated by the number of known agents, variety of damagingeffects, varying degrees of persistence and volatility, and multiple means of delivery. The environment isfurther complicated by employment of mixed chemical agents, mixed chemical and biological agents, orchemical agents combined with conventional ordnance. As with nuclear weapons, in addition to casualtiesamong unprotected soldiers, the varying degrees of contamination produced in the aftermath of a chemicalattack severely degrade the unit capability until decontamination is accomplished and the contaminated areais vacated. Detailed background information contained in FMs 3-3, 3-4, 8-9, 8-10-7, and 8-285 concerningthe chemical environment, as well as the nuclear and biological environments, must be clearly understoodby dental commanders and their subordinates.

9-8. Radiological Dispersal Device Environment

Radiation from RDD is a new dimension of the battlefield. Radiological dispersal devices can contaminatethe battlefield with radiation without the blast or thermal effects of a nuclear weapon. The radiation isspread by the use of high explosives. Personnel operating in the area can be exposed to varying levels ofradiation, from very low doses to very high doses. The effects on the body from this type of radiation canbe the same as exposure to the radiation from a nuclear detonation. Dental commanders must be preparedfor operations in this environment as they would in a nuclear environment.

9-9. Directed-Energy Environment

Directed-energy sources are becoming more prevalent on the modern battlefield and their presence will un-doubtedly increase in the future. This produces yet another dimension on the battlefield. Directed-energy

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sources include laser, microwave, or radio-frequency systems. Directed-energy sources are nondiscri-minatory. Adverse effects on dental units may result from inadvertent exposure to friendly use as well asenemy employment. Field Manual 8-50 provides additional information on the prevention and medicalmanagement of laser injuries.

Section III. DENTAL UNIT SURVIVAL IN A NUCLEAR, BIOLOGICAL,AND CHEMICAL ENVIRONMENT

9-10. General

Dental units must be able to survive an NBC attack, recover from its effects, and then continue the dentalcare mission. To survive and recover, a number of individual and collective tasks derived from theprinciples of NBC defense must be accomplished. Dental units are suitably equipped to perform thesetasks.

9-11. Principles of Nuclear, Biological, and Chemical Defense

The principles of NBC defense are discussed in the FM 3-Series manuals. These principles, brieflydiscussed below, apply to all dental units regardless of their location in the theater.

a. Avoidance. Avoidance measures consist of both active and protective measures.

(1) Active avoidance measures.

� Contamination detection.

� Contamination marking.

� Alarms and signals.

� Warning and reporting system.

� Contamination control.

(2) Passive avoidance measures.

� Training.

� Use of hardened positions.

� Dispersion.

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b. Protection.

� Hardening of positions and protecting personnel.

� Assuming mission-oriented protective posture (MOPP).

� Reacting to attack.

� Using collective protection.

c. Decontamination.

� Immediate decontamination.

� Operational decontamination.

� Thorough decontamination.

9-12. Nuclear-, Biological-, and Chemical-Related Clothing and Equipment

The TOE and appropriate CTA for dental units provide NBC equipment for the accomplishment of bothindividual and collective NBC survival tasks.

a. Individual Protective Equipment. Each soldier is provided with a protective mask with hood.Two sets of MOPP clothing (trousers, jacket, overboots, and gloves) are allocated each soldier by CTA 50-900. Other NBC items intended for individual use are the VGH ABC M8 Detector Paper, M291 SkinDecontaminating Kit, M295 Individual Equipment Decontamination Kit, nerve agent antidote autoinjectorsnerve agent pyridostigmine pretreatment tablets, and convulsant antidote for nerve agent. These items aremaintained in sufficient quantities by the unit to ensure initial and resupply issue for each soldier. FieldManual 8-285 prescribes the use of these items.

b. Nuclear-, Biological-, and Chemical-Related Equipment. The dental TOE provides forcommon items of NBC-related equipment.

c. Other Nuclear-, Biological-, and Chemical-Related Equipment. Common use NBC items notprescribed by TOE are listed in FM 3-Series NBC publications.

d. Nuclear-, Biological-, and Chemical-Related Repair Parts and Replenishment Supplies. Theunit must maintain stocks of NBC-related repair parts and replenishment supplies in accordance with thetechnical publications for the various items of equipment. Of particular importance among these items arereplacement filters, hoods, carriers, and other items for the protective mask. The unit�s NBC NCOmanages unit NBC supplies in coordination with the unit supply NCO and supervises maintenance on NBCequipment.

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e. Eyeglass Inserts for the Protective Mask. Soldiers who require eyeglasses for vision correctionare required to have one pair of prescription optical inserts for use with their protective mask. Opticalinserts are stored and maintained as part of that soldier�s mask.

9-13. Individual Tasks

Individual NBC-related survival tasks are common to all soldiers. Successful application of each task isessential to personal survival, as well as survival of the collective dental unit. These tasks must be drilledconstantly and incorporated into broader scale training. The NBC-related tasks, along with necessarytraining information, are covered in the Soldier Training Publication (STP) 21-1-Soldier�s Manual ofCommon Tasks.

9-14. Collective Unit Tasks

Collective NBC tasks are generally accomplished by members of the unit organized into teams or bydesignated members of the unit. The successful performance of individual tasks is necessary foraccomplishment of the various collective tasks, and ultimately, unit survival. Collective tasks which dentalunits must be prepared to perform in an NBC environment are derived from the principles of NBC defense.

9-15. Decontamination

a. Basic Principles. Decontamination is costly in terms of manpower, time, space, and materiel,and merits special discussion. Decontamination is essential for survival, but must be balanced with therequirement to continue the mission. Decontamination operations are based on the following four basicprinciples:

� SPEED�Decontaminate as soon as possible to restore full potential.

� NEED�Decontaminate only that which is necessary.

� LIMIT�Decontaminate as close to the site of contamination as possible.

� PRIORITY�Decontaminate items in order of importance to mission accomplishment.

b. Immediate Decontamination. Dental personnel must perform immediate decontamination ofthemselves and their buddy to prevent the effects of NBC contamination. Personnel should use their M291(Skin Decontamination Kit) for skin decontamination and their M295 (Individual Equipment Decontami-nation Kit) to decontaminate their personal equipment.

c. Operational Decontamination. Dental units are capable of conducting operational decontami-nation using only organic resources. Field Manual 3-5 describes in detail the procedures for operationaldecontamination, which include MOPP gear exchange and vehicle washdown.

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d. Thorough Decontamination. Thorough decontamination is the most resource-intensive type ofdecontamination and requires external support from supporting decontamination units. Field Manual 3-5describes in detail the procedures for thorough decontamination, which include decontamination of troopsand equipment. Keep in mind that the supporting decontamination unit is in charge of both the decon-tamination site and the decontamination operation.

NOTE

Dental units require external support for conduct of thorough decon-tamination.

9-16. Dental Support During Nuclear, Biological, and Chemical Operations

A dental unit�s operation in an NBC environment is limited. The commander is ultimately responsible fordental unit activities during NBC operations; however, he will generally delegate planning and supervisoryresponsibility to an appointed NBC officer. The unit NBC NCO provides technical advice to the commanderand NBC officer; he supervises personnel providing support relative to NBC operations and training. Unitheadquarters executes a number of NBC-related tasks.

a. Establishment of Nuclear, Biological, and Chemical Procedures. Nuclear, biological, andchemical procedures are incorporated in the unit�s TSOP. Key personnel such as the NBC officer areappointed on orders. Personnel requirements for decontamination, survey, and monitoring teams aredetermined, and designated personnel are appointed on orders.

b. Nuclear, Biological, and Chemical Warning and Reporting System. The unit headquarterscoordinates implementation of the NBC warning and reporting system�receiving, generating, or dissemi-nating the NBC reports. Field Manual 3-3 discusses the use and formats for these reports.

c. Establish the Unit Operational Exposure Guide and Maintain Records of RadiologicalExposure. The commander establishes the radiation operational exposure guide for the unit. The unitheadquarters maintains a record of exposure of its personnel to radiological hazards. This information isused in generating a radiation status report to higher headquarters. Exposure of x-ray personnel asindicated on their IM-9/PD radiacmeter must be included in this record.

d. Operational Planning and Intelligence. The medical brigade is responsible for disseminatingNBC information to its subordinate units, which includes the dental unit. The NBC information received isused by the dental unit to develop its overall operational plan.

9-17. Mission-Oriented Protective Posture

The most important headquarters function for dental unit survival during NBC operations is the establishmentof MOPP level, a decision that rests solely with the commander. Mission-oriented protective posture is the

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flexible use of protective clothing and equipment that balances protection with performance degradation.The higher the MOPP level, the more protection it affords, but the more it degrades performance throughgeneration of heat, stress, and reduced efficiency. Detailed guidance on individual NBC protection andMOPP is provided in FM 3-4. Keep in mind that MOPP is not a rigid policy, but must be applied withcommon sense and flexibility. To determine the appropriate MOPP level, the commander conducts aMOPP analysis which weighs mission; work rate and duration; probable warning time; terrain, weather,and time of day; unit training and additional protection available; alarm placement; and automatic maskingpolicy.

Section IV. DENTAL TREATMENT OPERATIONS IN A NUCLEAR,BIOLOGICAL, AND CHEMICAL ENVIRONMENT

9-18. General

As a general rule, in the aftermath of an NBC attack, dental treatment operations cease until thoroughdecontamination of the unit and its equipment has been accomplished. Only maxillofacial injuries of animmediate life-threatening nature should be considered for treatment. After an attack, the resources of theDTF are redirected toward decontamination and relocation to a noncontaminated area, or toward support toan adjacent MTF for any mass casualty situation that may have been generated. See Chapter 8 forinformation on additional wartime role.

9-19. Patient Treatment Considerations

The only category of dental treatment appropriate in an NBC environment is operational care-emergency;and then, only those emergencies of an extreme nature which demand immediate attention. The most likelycondition requiring such attention would result from maxillofacial trauma and the patient should betransported to a MTF rather than a DTF.

a. Patient Decontamination. Decontamination of patients must be accomplished before theyenter a MTF. Contaminated patients are triaged separately and decontaminated prior to treatment unlessimmediate limb or lifesaving care is required. The decontamination process may be interrupted to providesuch care. Patient decontamination falls into the category of thorough decontamination. Specific details ofpatient decontamination are contained in FM 8-10-7. Performance of patient decontamination is not anappropriate additional wartime role for dental personnel. However, dental personnel may be called upon toassist in providing medical care in this environment. All personnel should be trained to handle contaminatedcasualties when necessary. Initial decontamination at the basic skill level is accomplished at the casualty�sunit. Patient decontamination teams made up of personnel from the supported unit and supervised bymedical personnel accomplish decontamination at an MTF, not at a DTF.

b. Patient Decontamination by Dental Treatment Facilities. Neither dental units nor theirsubordinate DTFs are equipped to support detailed patient decontamination. Contaminated patients requiring

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urgent attention which may present at a DTF must be directed or evacuated to the nearest MTF with apatient decontamination capability prior to treatment.

9-20. Patient Protection

Dental treatment facilities must also consider the need to protect patients in their care in the event of NBCattack or when the threat of an attack is high. Special consideration must be made for maxillofacial patientswhose condition prevents them from wearing a standard protective mask.

a. Immediate Response. In the event of an attack or when the alarm sounds, the dental treatmentproviders immediately cease work and mask. The patient should do likewise. After donning their ownmasks, dental treatment providers should assist the patient, if necessary, by removing materials that impedethe patient�s masking. Only those materials that impede masking or may compromise the airway (forexample, rubber dam frames or impressions) are removed. The rest are left in place until the all clear issounded. Special attention must be given to patients who may have been medicated into a less than fullyconscious state or otherwise incapacitated.

b. Mission-Oriented Protective Posture Level Considerations. The MOPP level should be takeninto account when determining the category and extent of dental treatment to be provided. Patients,including those seated in the dental chair, should be at the MOPP level prescribed for the DTF by its parentheadquarters. Dental treatment at MOPP Levels 3 and 4 is, of course, rendered impossible by therequirement to wear the protective mask; however, treatment is still possible at Levels 0 through 2.Treatment at Level 2 should be limited only to EMERGENCY category care requiring urgent attention. AtMOPP Level 1, most types of dental emergencies can be accommodated; however, only minimum essentialtreatment should be undertaken. The MOPP Level 0 generally does not limit the provision of dentaltreatment; however, the degree of the NBC threat forecast for the area should be considered before under-taking extensive treatment. Refer to FM 3-4 for additional information on MOPP levels.

c. Maxillofacial Injuries. Patients with maxillofacial injuries, which prevent proper fit and sealof the individual protective mask, must be evacuated to an MTF for treatment when the threat of an NBCattack is imminent. This is due to the fact that these patients cannot mask and must be placed in a patientprotective wrap after decontamination and treatment at the MTF.

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CHAPTER 10

SUPPLY AND SERVICES, MAINTENANCE,AND COMBAT HEALTH SUPPORT


10-1. General

Supply and maintenance are key factors in the sustainment of dental service operations. Both of these areasimpact heavily on unit readiness and are a subject of intense command interest throughout the chain ofcommand. While the senior dental NCO is tasked with overseeing unit administration, the executive officeris tasked with overseeing supply and maintenance operations.

10-2. Unit Supply and Maintenance Personnel

The TOE for the medical company (dental service) provides a sufficient number of specialists, along withthe necessary equipment, to conduct unit-level general and medical supply operations. This includes motormaintenance, material-handling equipment, power-generation equipment, upkeep of hand and power tools,and battlefield recovery operations of nonmedical equipment. Further, unit supply and maintenancepersonnel perform preventive maintenance checks and services, troubleshooting to isolate malfunctioning ordefective components and/or boards on medically related equipment. Additional, they�

a. Establish and maintain stock records and other documents, such as inventory, materiel control,and accounting and supply reports, maintaining automated and manual accounting records; and post receiptsand turn-in, due-in, and due-out accounts. They also verify quantities received against bills of lading,contracts, purchase requests, and shipping documents; and they unload, unpack, visually inspect, count,segregate, palletize, and store incoming supplies and equipment.

b. Maintain quality control, inventory control, repair parts management, distribution, supplymanagement for all classes of supply (except Class VIII), and property management.

Section II. SUPPLY AND SERVICES

10-3. General

Resupply of materiel consumed during the course of an operation is a major function of the companysupport section. The procurement of supplies is a prime function of the supply system; however, there areother aspects of this system which are of great concern to the commander; these include�

� Property accountability, responsibility, and security.

� Maintenance and disposition of supply records.

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� Reporting of unsatisfactory medical materiel items.

� Inventory.

� Investigation and report of survey for lost and damaged property.

Discussion of specific procedures relating to the supply and service system is not appropriate in thispublication; however, the company commander and staff must develop a thorough understanding of theseprocedures. The remainder of this section deals primarily with dental supply operations in the TO. Refer toARs 40-61 and 710-2 for additional guidance on property management.

10-4. Classes of Supply

Supplies are categorized into ten classes. Dental units consume supplies from each of the ten classes invarying amounts. For dental units, these ten classes of supply are broken down into two general categories�medical supply and nonmedical supply. Management of medical supplies is the responsibility of the unit�smedical supply specialist. The other nonmedical nine classes of supply are managed, in most cases, by theunit supply sergeant.

10-5. Medical Supply Operations

Dental units consume a significant amount of dental materials (medical supply) during the course of patienttreatment operations, particularly when general and specialty care is being provided. An efficient systemfor replenishing those materials must be established within the unit and with the supporting medical logistics(MEDLOG) battalion.

a. The dental clinic and forward treatment teams receive their resupply from the unit�s medicalsupply specialist. The medical supply specialist consolidates supply requirements, prepares DA Form 3161in accordance with DA Pamphlet (Pam) 710-2-1, and forwards the request to the supporting MEDLOGbattalion.

b. Distribution of medical supplies within the dental unit is by one of two methods. Unitdistribution is the most common method used when the unit�s DTF is in the assigned area. Supplies arepicked up by the unit�s headquarters personnel from the supply point and delivered to the DTF, usingorganic vehicles. Supply point distribution is used when the DTF is located at an inconvenient distancefrom the unit headquarters section. In this case, the affected DTF establishes accounts directly with theMEDLOG battalion or one of its forward or area support platoons, rather than going through the unit�smedical supply specialist. When DTF use supply point distribution, they must continue to report expenditureand replenishment to the unit so the commander can remain abreast of the supply situation. When a forwardtreatment team has a long-term relationship with a host unit, such as a hospital or medical company, aprovisional method should be considered whereby the forward treatment team obtains its supplies throughthe host unit. Supply distribution should be a matter for inclusion in the unit TSOP as well as specified inorders and plans developed by higher headquarters.

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10-6. Unit Supply Operations

The medical supply specialist manages Class VIII supplies and the unit supply sergeant manages all otherclasses with the exception of Class IX, repair parts. Management of repair parts is the responsibility of theunit equipment repair/parts specialist. Management of the various nonmedical classes of supply is essentiallythe same as for Class VIII; however, distribution and source will vary with the class of supply. Class IXrepair parts resupply is more commonly associated with the maintenance system rather than the supplysystem. As part of the repair parts system, dental units carry a prescribed load list (PLL) of repair parts andmaintenance-related items to ensure that high demand repair parts are immediately on hand for use by unitmaintenance personnel. Guidance on repair parts and PLL stockage is provided in DA Pam 710-2-1.

Section III. MAINTENANCE

10-7. General

Maintenance of vehicles and equipment is a critical aspect of sustainment in the TO. The unit that fails tomaintain its equipment in good operating order will fail to accomplish its mission. The overall objective is toassure that materiel is maintained in a ready condition to fulfill its intended purpose. The dental companyhas a significant maintenance capability.

10-8. The Army Maintenance System

Army Regulation 750-1 prescribes the basic concepts, objectives, policies, and procedures for themaintenance of Army materiel. Guidance for implementation of The Army Maintenance ManagementSystem is provided in DA Pam 738-750. Technical Bulletin 38-750-2 adapts DA Pam 738-750 for use withmedical equipment. Dental commanders must be well versed in the contents of all of these publications.

10-9. Preventive Maintenance

Preventive maintenance is the care and servicing to maintain equipment and facilities in satisfactory operatingcondition. It is provided through systematic inspection, detection, and correction of incipient failuresbefore they occur or before they develop into major defects. Preventive maintenance is the responsibility ofcommanders at all echelons and is accomplished by user and maintenance personnel. Also, commandersare responsible for ensuring that maintenance of equipment is performed in accordance with publishedmaintenance doctrine at the lowest category consistent with the repair parts, tools, and skills available (AR750-1).

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APPENDIX A

DENTAL SERVICE SUPPORT UNDER THEMEDICAL REENGINEERING INITIATIVE

A-1. General

The L-edition TOE for dental support will be used until the A-edition is activated. The MRI will requiresignificant reorganization for DSS personnel and will be more responsive to Echelons II, III, and IVoperational needs. The following paragraphs describe in detail MRI for DSS. The dental mission willremain the same; however, treatment capabilities will be significantly improved when compared to theMF2K medical company (dental service) and the medical detachment (medical service) capabilities. (Seeparagraph A-8 for a comparison of MRI Force XXI and MF2K.)

A-2. Dental Staff

Coordination of the collective efforts of unit, hospital, and area dental support activities with the overallCHS operation is accomplished through dental representation on appropriate command and control staffs,usually in the form of a command dental surgeon. The dental surgeon is a special staff officer under thecoordinating staff supervision of the S1/G1. In the medical brigade, the dental surgeon is a separate TOEposition. In divisions, the comprehensive dental officer assigned to the main support battalion of theDISCOM fills this position. A dental unit commander who also serves as the dental surgeon is described asbeing �dual-hatted.� In some cases, the dental surgeon position is not clearly identified and becomes anad hoc arrangement. In all of these cases, the dental surgeon works closely with the command surgeon toaccomplish the mission. Staff advocacy is a critical element in the development of a coordinated DSSsystem throughout the TO.

A-3. Dental Staff Responsibilities

a. The dental staff officer provides input to the commander on policy, procedures, and plans that con-cern oral health and dental care. He prepares the dental estimate and assists in preparing the dental portionof the HSS operation plan (refer to FM 8-55 for information concerning the preparation of HSS estimatesand plans). He assists in writing the dental support portion of OPORD. He provides technical guidance ondental matters to subordinate dental resources. He monitors the oral health of the supported population, thereadiness of unit dental assets, and the tactical and strategic situation of supported units. He also assessesCHS plans to determine dental resource requirements. Specific duties may include surveillance of�

(1) Severe oral and maxillofacial surgery cases in hospitals.

(2) Status of dental resources in the AOR.

(3) Operational requirements of supported troops (for example, number and types of unitssupported or in the area of responsibility; number of troops in supported units or AOR; tactical and strategicsituation; location and distribution of supported units, and expressed needs of commanders).

(4) The provision of dental services to EPW, refugees, and others.

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b. The dental staff officer also serves as advisor to the commander on dental matters. On thebasis of the information from surveillance, he makes recommendations concerning oral health and dentaldelivery for plans, OPORD, and policy.

A-4. Dental Staff Officer Positions

a. Division. The senior dental officer in a division is assigned to the main support battalion. Inaddition to his patient care responsibilities, he acts as the division dental surgeon and exercises technicalsupervision over the dental assets in the division forward support battalions. Dental officers in the forwardsupport battalions serve as dental surgeons to the supported maneuver brigades.

b. Separate Brigades, Armored Cavalry Regiments, and Special Forces Groups. The dentalofficer in the medical element of these units also serves as dental surgeon for the parent unit.

c. Medical Brigade (Corps: TOE 08422A1000, COMMZ: TOE 08422A2000). The senior MRIDental Company Area Support Commander is dual hatted as the brigade dental surgeon and located in thecommand section of this brigade. He exercises technical control over dental assets in hospitals and dentalunits subordinate to the medical brigade. Dental surgeons of corps medical brigades are dual-hatted as thecorps dental surgeon and provide technical supervision for unit-level dental support (in divisions, separatebrigades, and ACR) as well as for dental assets assigned within the brigade. A senior dental NCO assignedto the security, plans, and operations section assists the medical brigade dental surgeon.

d. Medical Command (TOE 08611A000). There are two dental staff officers in the headquarterscompany.

(1) The MEDCOM dental surgeon establishes and disseminates Army theater policy ondental matters. He exercises technical control over all dental units in the TO through the medical brigadedental surgeons. He directs the dental service element of the headquarters and provides dental staff supportto the MEDCOM commander.

(2) The MEDCOM preventive dentistry officer supports the MEDCOM dental surgeon andassistant dental surgeon in all staff actions. Specific duties include�

� Providing oral health surveillance information in support of policy and proceduredevelopment.

� Developing plans and orders concerning oral fitness and preventive dentistryprograms.

� Recommending treatment policies.

� Developing programs for dental support of humanitarian and civic action operations.

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A-5. Dental Company (Area Support), TOE 08478A000

The newly developed dental company area support (DCAS) is a product of the MRI. When activated, it willreplace the current dental battalion now in place under MF2K. The clinical and forward treatmentcapabilities are significantly improved when compared to the MF2K medical company (dental service) andthe medical detachment (dental service). The DCAS is the only dental unit in the TO. The DCAS willprovide field dental clinics in the corps and EAC and will deploy forward treatment teams to the divisionand brigade areas in the CZ. These teams will augment and reinforce medical units with organic dentalassets.

a. The MRI DCAS has 91 enlisted and officer personnel, organized into four sections (see FigureA-1).

Figure A-1. Dental Company, Area Support, TOE 08478A000.

b. The headquarters and support section is composed of the commander, the executive officer,and the company�s first sergeant, along with 17 support personnel. These support personnel specialize inNBC operations; unit supply; health service logistics; administration; and automotive repair, powergeneration, and medical equipment maintenance. A cook is assigned, but as the company does not have thecapability for independent field feeding, the cook is generally attached to the supporting field feedingfacility.

c. The dental clinic area support is composed of a specialty and general dentistry sections. Thespecialty section is composed of a comprehensive dentist, a periodontist, an endodontist, a prosthodontist, a

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chief dental facility NCO, two preventive dentistry specialists, a dental laboratory specialist, and supportingdental specialists. The general dentistry section is composed of five general dental officers, a dental facilityNCO, two preventive dentistry specialists, and supporting dental specialists.

d. The forward treatment platoon is composed of three forward treatment sections and aheadquarters section. Each forward treatment section is composed of six dental teams. The officer incharge of each section is a major. A dental NCO and dental specialists assist the dental officers. Theplatoon leader and chief dental facility NCO are responsible for nonclinical support activities.

e. The forward treatment teams are 50 percent mobile and will reinforce and reconstitute organicdivision dental assets; during mass casualty situations, the teams will augment medical assets.

f. The dental company has a BOA of one per 44,000.

A-6. Employment of the Dental Company Area Support

The DCAS is the only TOE dental unit in the TO. The DCAS will provide field dental clinics in the corpsand EAC. It will deploy forward treatment teams to the division and brigade areas in the CZ. These teamswill augment and reinforce medical units with organic dental assets.

a. Dental Company Area Support. The DCAS is generally subordinate to the medical brigade ofthe corps MEDCOM, however, they could be directly assigned to the corps MEDCOM and theaterMEDCOM. The number of DCAS employed will depend on the density of troop population to besupported, the size of the geographic area to be served, and Army fielding plans.

b. Phased Employment of Dental Services. Current capability based on organization andequipment provides dental units, individually and collectively, the flexibility and adaptability to providedental support at all levels of warfare from the initial stages of the conflict until hostilities cease and USpresence is terminated. Medical casualties are principally a function of combat activity and DNBI; however,dental casualties are principally a function of time. If a high state of dental readiness is assumed for troopsbefore deployment, it follows that requirements for DSS units in the theater will increase as the theatermatures.

c. Levels of Dental Services. As capability to provide dental services increases, so does theweight and cube of materiel necessary to provide that capability. Emergency dental kits are negligible inweight and cube; however, capability is severely limited. To provide the full clinical capability of theDCAS will require the larger dental equipment sets. In the earlier stages of deployment, capability fordental services must be balanced with the availability of scarce transportation assets and other priorities.Fortunately, the demand for treatment during earlier stages of deployment is relatively light and can besatisfied by fewer dental assets and lower levels of care. The phased employment of dental support into aTO will be a function of time and phase of combat operations. As always, planning is the key to successfuldevelopment of theater dental support. It is incumbent on dental service planners at all levels to coordinatethe employment of dental units in the theater throughout the operation and, in particular, during thepredeployment planning phase.

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A-7. Command, Control, Communications, Computers�Intelligence, Surveillance and Recon-naissance

Previously this appendix discussed operational tasks that must be performed by dental units across thecontinuum of military operations to include stability operations, and support operations, joint and combinedoperations in order to successfully accomplish the mission. Command and Control is yet another task thatmust be accomplished. It is addressed separately because it is an inherent part of each previously discussedtask, as well as the means of coordinating all of the tasks toward the single objective of missionaccomplishment.

a. Organizational Concept. The DCAS will be assigned to the Theater/Corps MEDCOM forC2. If there is no MEDCOM assigned, the DCAS will be assigned to the medical brigade. Elements(teams) from the DCAS may be attached to ASMB, as the supported operation requires. The dental sectionin the MEDCOM will coordinate the spectrum of dental support for an operation. In the absence of aMEDCOM, the senior DCAS Commander would function in a �dual hat� role as the medical brigade dentalsurgeon and thereby coordinate dental support for an operation. Overall control of dental resources in anoperation or CZ may be complicated because approximately one-third of the dental officers assigned toTOE organizations do not fall under direct dental C2. Additional account must be taken of large geographicseparations and the lack of extended communication systems. In order to maximize dental support, it isnecessary to synchronize the activities of all dental resources available to the operation. This requiresflexibility on the part of the commander and innovative application of C2 doctrine. Medical communicationsfor combat casualty care (MC4) in conjunction with the Joint Theater Medical Information Program(J-TMIP) will provide the linkages necessary to achieve this.

b. General Capabilities. The MC4 is the AMEDD�s initiative to link units in the theater, notonly with the Global Combat Support System-Army, the Combat Service Support Control System, and theForce XXI Battle Command Brigade and Below, but also to provide C2 capabilities. The broad scope ofMC4 will provide a method of linking health care providers and diagnostics systems together into aseamless, diagnostic, treatment, situational awareness, and evacuation information network. Integration ofexisting and emerging digital communications technologies into the CHS system will begin with theindividual soldier and proceed through the health care continuum. This will allow the AMEDD to identifypreventive medical requirements and necessary treatment ensuring sustainability of the force.

c. Operational Concept. The MC4 will allow the patient access to dental treatment by enablingthe patient to arrive at a treatment facility, or by taking the treatment capability to the patient. The unitcommander will know the dental readiness status of his command and will know when and where hissoldiers are located within the CHS system. The commander can determine who will be RTD and who willnot. Higher level commanders will have the ability to get a broader picture of the general status of forcesunder their command and will know which assets are available to fill key locations. Class VIII supplies willflow to the precise location at the right time and in the correct amount.

d. Specific Capabilities. Dental care capability exists in Echelons II, III, IV, and V. The MC4will provide an automated reporting capability with dental-specific operational data elements at theseechelons. This will include integration of dental data elements into the Computerized Patient Medical/Dental Record. The MC4 will allow dental personnel at Echelon II to coordinate with dental elements at

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Echelon III�V (to include hospital based oral and maxillofacial surgery services). Dental elements requirethe communication capabilities and linkages to ensure seamless integration of CHS. This will assure theintegration of the ten AMEDD functional areas within themselves and with the Army and Joint systems ofthe twenty-first century.

A-8. Proposed Changes to the Tables of Organization and Equipment by Implementing the MedicalReengineering Initiative

The reorganization of DSS under MRI will�

a. Eliminate�

� Six hundred and eight personnel currently assigned in the L-Edition MF2K TOE for DSSin the TO.

� The dental battalion and reorganize it into a robust, modular designed, mobile dentalcompany.

� The dental units in the National Guard, servicewide.

� Providing medical equipment maintenance and Class VIII supply to subordinate units ofthe dental battalion.

b. Reduce�

� The overall total number of DSS units.

� The need to evacuate a majority of dental patients/casualties beyond Echelon III MTF intheater.

� Communications requirements.

c. Increase�

� The total weight and cubic requirements of the dental company in the TO.

� The number of personnel within the dental company.

� The dental capability within Echelon II.

� The dependence upon appropriate elements of corps or division for legal, finance,personnel, administrative, and food services; supplemental transportation support; religious support; laundry,bath, and post exchange services, patient decontamination; and security of treated EPW.

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� The support capability of the forward treatment platoon will support 21,000 troops (eachteam can support 1,125 troops).

d. Provide�

� Up to 18 modular mobile forward treatment teams for area support where only 6 wereavailable under the current L-Edition TOE.

� More immediate care to a larger number of troops in Echelon II within the TO at point ofneed.

� An increase in the number of general dentists at Echelon II.

� Increased mobility of treatment teams closer to the front of Echelon II.

� Fifty percent mobility of each of the modular mobile forward treatment teams.

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APPENDIX B

STANDARDIZED DENTAL CLASSIFICATION SYSTEM

Good oral health is essential to readiness posture of our forces. An excellent Standard Dental ClassificationSystem has been developed by Department of Defense (DOD) Health Affairs (HA) to identify varyingdegrees of dental health and readiness. In order to assure ongoing continuity of dental classification for allmilitary personnel, this policy memorandum establishes policy on Dental Classifications for the DOD and isprinted here in its entirety (HA Policy 97-020). Dental patients shall be classified as follows:

a. Class 1. Patients not requiring dental treatment or reevaluation within 12 months. Criteria:

(1) No dental caries or defective restorations.

(2) Arrested caries for which treatment is not indicated.

(3) Healthy periodontium, no bleeding on probing; oral prophylaxis not indicated.

(4) Replacement of missing teeth not indicated.

(5) Unerupted, partially erupted, or malposed teeth that are without historical, clinical, orradiographic signs or symptoms of pathosis and are not recommended for prophylactic removal.

b. Class 2. Patients who have oral conditions that, if not treated or followed up, have thepotential but are not expected to result in dental emergencies within 12 months. Criteria:

(1) Treatment or follow up indicated for dental caries with minimal extension into dentin orminor defective restorations easily maintained by the patient where the condition does not cause definitivesymptoms.

(2) Interim restorations or prostheses that can be maintained by the patient for a 12-monthperiod. This includes teeth that have been restored with permanent restorative materials, but for whichprotective coverage is indicated.

(3) Edentulous areas requiring prostheses, but not on an immediate basis.

(4) Periodontal disease or periodontium exhibiting�

(a) Requirement for oral prophylaxis.

(b) Requirement for maintenance therapy; this includes stable or nonprogressive muco-gingival conditions requiring periodic evaluation.

(c) Nonspecific gingivitis.

(d) Early or mild adult periodontitis.

(5) Unerupted, partially erupted, or malposed teeth that are without historical, clinical, orradiographic signs or symptoms of pathosis, but which are recommended for prophylactic removal.

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FM 4-02.19

(6) Active orthodontic treatment.

(7) Temporomandibular disorder patients in maintenance therapy.

c. Class 3. Patients who have oral conditions that if not treated are expected to result in dentalemergencies within 12 months. Patients should be placed in Class 3 when there are questions in determiningclassification between Class 2 and Class 3. Criteria:

(1) Dental caries, tooth fractures, or defective restorations where the condition extendsbeyond the dentinoenamel junction and causes definitive symptoms; dental caries with moderate or advancedextension into the dentin; and defective restorations not maintained by the patient.

(2) Interim restorations or prostheses that cannot be maintained for a 12-month period. Thisincludes teeth that have been restored with permanent restorative materials, but for which protectivecoverage is indicated.

(3) Periodontal disease or periodontium exhibiting�

(a) Acute gingivitis or pericoronitis.

(b) Active moderate to advanced periodontitis.

(c) Periodontal abscess.

(d) Progressive mucogingival condition.

(e) Periodontal manifestations of systemic disease or hormonal disturbances.

(4) Edentulous areas or teeth requiring immediate prosthodontics treatment for adequatemastication, communication, or acceptable esthetics.

(5) Unerupted, partially erupted, or malposed teeth with historical, clinical, or radiographicsigns or symptoms of pathosis that are recommended for removal.

(6) Chronic oral infections or other pathologic lesions.

(a) Pulpal or periapical pathology requiring treatment.

(b) Lesions requiring biopsy or awaiting biopsy report.

(7) Emergency situations requiring therapy to relieve pain, treat trauma, and/or acute oralinfections, or provide timely follow-up care (for example, drain or suture removal) until resolved.

(8) Temporomandibular disorders requiring active treatment.

d. Class 4. Patients who require dental examinations. This includes patients who require annualor other required dental examinations and patients whose dental classifications are unknown.

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FM 4-02.19

APPENDIX C

QUALITY ASSURANCE PLAN

C-1. General

Quality assurance is an aspect of health care delivery that has greatly received increased visibility. Inresponse, The Surgeon General has implemented a dynamic system of continuous checks and balances.This is a quality assurance plan. The objectives of the plan are to�

� Deliver dental care consistent with the capabilities of the treatment facility and staffqualifications.

� Reduce risk-creating incidents for the patients treated.

� Improve provider-patient communication and patient satisfaction.

� Evaluate practitioner performance objectively.

With respect to dental service, AR 40-68 addresses four major areas of interest�patient care evaluation,credentials/privileges, utilization management, and risk management. A detailed plan for implementation isalso described.

C-2. Quality Assurance in the Theater of Operations

The commander is responsible for the management of the unit�s quality assurance plan. Guidance andpolicy on quality assurance matters comes from the technical/staff dental surgeon channels. As with othermatters for which policy is stated in references directed at peacetime care and organizations, qualityassurance policy in AR 40-68 must be modified to fit the tactical situation. In any case, the spirit of qualityassurance must be addressed. The soldier in the TO should have access to the highest possible quality ofdental care, consistent with the tactical circumstances, as he would receive in a garrison dental facility.Establishment of a sound quality assurance plan by dental commanders and staff dental surgeons at all levelshelps to ensure the individual soldier�s accessibility.

C-3. Patient Care Evaluation

In the area of patient care evaluation, a system is required to evaluate the quality and appropriateness of thecare provided. This system should also ensure that appropriate dental treatment records are compiled andmaintained. Periodic audits also aids the commander and staff dental surgeons in evaluating distribution ofcare and compliance with theater treatment policies regarding the type of care to be provided. Dentalradiology, infection control, and barrier protection are areas that should be of special command interest inthe field environment.

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C-4. Utilization Management

a. The tactical situation dictates to a large degree the type and availability of dental care in theTO. However, the principle of utilization management, providing the highest quality dental care possible inan efficient manner, should be the goal of DSS in the TO.

b. Army Regulation 40-68 directs the dental utilization management program to review�

(1) Time management in patient care.

(2) Patient waiting time.

(3) Number of patients treated per unit of practitioner�s time.

(4) Equipment and facility management.

(5) Logistics management.

c. Emergency and preventive care should be rendered as far forward as possible. This will resultin the immediate RTD of the soldier and minimal evacuation of dental emergencies to the rear as soon aspossible. Preventive, general, and specialty care will be rendered at the convenience (to include locationand time) of the supported units to improve their level of oral health and to minimize the number of dentalemergencies.

C-5. Risk Management

The risk management program is concerned with the prevention of accident and injury. For dental supportin the TO, it encompasses the reduction of risk to patients, visitors, and unit personnel. For moreinformation concerning this subject, see FM 100-14.

C-6. Dental Radiology

Some of the major considerations for dental radiology quality assurance in the TO are�

a. All personnel operating dental x-ray units in the field should know and minimize the risks, toinclude�

(1) The proper way to set up and operate the equipment.

(2) The techniques of substituting distance for shielding during x-ray operations.

(3) Ensuring that exclusion areas are clear of all personnel prior to operation of the x-ray.

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FM 4-02.19

(4) The proper way to develop radiographs and the hazards of the materials used.

b. All dental x-ray operators should have dosimeters (IM-9/PD) and these dosimeters must behandled and processed correctly.

c. All radiographic information must be entered in the patient�s records.

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FM 4-02.19

APPENDIX D

SAMPLE OUTLINE FOR A CLINICAL STANDINGOPERATING PROCEDURE

D-1. General

The CSOP discusses only that information relating to clinical operations. The CSOP primarily coverspolicies and procedures. Policies are generally dictated through the dental technical chain and are notusually subject to a great deal of interpretation. Procedures selected for inclusion in the CSOP are thosewhich meet the company�s clinical mission. As with the TSOP, there is no officially authorized format fora CSOP; however, the information contained in paragraphs D-2 through D-7 of this appendix offers asuggested outline and format.

D-2. Publication Format

The most often used format for the CSOP is a loose-leaf binder arrangement. Clinical policies andprocedures are subject to frequent change, and a loose-leaf arrangement can be easily updated. It is alsorelatively inexpensive and easily produced in multiple copies at the unit level.

D-3. Organization

Annexes with supporting appendixes and tabs are easy to change and update; therefore, maximum use ofannexes in a CSOP is advisable. The CSOP should be organized as follows:

� Directive.

� Table of contents.

� Record of changes and corrections.

� Annexes, appendixes, and tabs.

D-4. Directive

The commander�s directive should be the first page of the CSOP. This directive is a letter order signed bythe commander that directs implementation of the CSOP. The directive should be on company letterhead inmemorandum format.

D-5. Record of Changes and Corrections

Since information in the CSOP is subject to frequent change, include a page in the front of the binder torecord changes and corrections. This allows the user and the DTF OIC to easily audit that particular copyof the CSOP. A single page formatted as shown in Figure D-1 will serve this purpose.

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RECORD OF CHANGES AND CORRECTIONS

(DTF Designation) of (Unit Designation) CSOP

NUMBER DESCRIPTION AUTHORITY DATE ENTERED BY_________ ______________ ____________ _____ ______________________ ______________ ____________ _____ ______________________ ______________ ____________ _____ ______________________ ______________ ____________ _____ _____________

Figure D-1. Format for changes and corrections.

D-6. Annexes

Information in the CSOP is incorporated into annexes dealing with general areas. Annexes are supportedby appendixes and tabs that deal with more specific issues. Information in annexes and supportingappendixes and tabs should not be redundant, nor voluminous. However, there should be sufficient detail toensure proper performance of the task addressed or compliance with the policy prescribed. As with theTSOP, annexes to the CSOP are directive and address who, what, where, when, and how. Annexes areattached in alphabetical order after the body of the table of contents, with appendixes (numerical) and tabs(alphabetical) following their supported annexes. Annexes are generally formatted in the same mannerprescribed for the TSOP (see paragraph E-7); however, as a matter of expediency and economy, somematerial may be incorporated as an appendix or tab in its original form simply by adding a tab or appendixdesignator. Some examples of this method are manufacturer�s instruction manuals, military technicalmanuals, or written policy directives from higher headquarters.

D-7. Content

The information contained in annexes is variable and will depend on the type of unit and, of course,guidance and policy from the unit commander and his higher headquarters. The following is an outline ofannexes, appendixes, and tabs recommended for inclusion in a generic CSOP.

� ANNEX A�Organization. A general statement of the mission and organization of thecompany.

� APPENDIX 1�Dental Treatment Facility Layout. Line diagram of the suggested DTFlayout.

� TAB A�Vehicle Load Plans. Load plans for the DTF�s personnel and equipment.

� APPENDIX 2�Personnel. Organization of personnel assigned to the DTF and delin-eation of duties.

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FM 4-02.19

� TAB A�Duty Description. Detailed description of individual and special duties asnecessary.

� ANNEX B�Equipment. Listing of equipment assigned to the DTF.

� APPENDIX 1�Operation and Maintenance. Statement of DTF policy for equipmentoperation and operator maintenance.

� TAB A�Individual Major Items. Manufacturer�s operator manual or servicetechnical manual, if available, for each major item of equipment, to include vehicles and generators.

� APPENDIX 2�Maintenance Support Procedures. Prescribe procedure for obtainingmaintenance support.

� ANNEX C�Supply.

� APPENDIX 1�Class VIII Medical Supply. Statement of procedure for ordering,receiving, storing, and issuing Class VIII medical supplies.

� APPENDIX 2�Property Control. Hand receipt procedure for maintaining accountabilityof the DTF�s TOE and CTA property.

� APPENDIX 3�Precious Metals Control. Procedure for control of precious metals andfinished fixed prosthodontic cases, if appropriate.

� ANNEX D�Patient Care Operations.

� APPENDIX 1�Patient Treatment Policy. Statement of treatment policy, to includepriority of care, if appropriates.

� TAB A�Policy letters from higher headquarters.

� APPENDIX 2�Patient Flow. Prescribe patient flow.

� APPENDIX 3�Patient Records. Prescribe procedure for preparation and maintenanceof patient records.

� APPENDIX 4�Workload Reporting. Prescribe procedure for workload data account-ability and reporting.

� APPENDIX 5�X-ray Operations. Prescribe procedure for x-ray operations.

� APPENDIX 6�Preventive Dentistry. Describe and define responsibilities for the DTF�spreventive dentistry program.

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FM 4-02.19

� APPENDIX 7�Prosthodontic Care. Prescribe procedure for provision of prosthodonticcare, if appropriate.

� APPENDIX 8�Referrals. Prescribe procedure for referral and evacuation of patientsfor treatment available at other DTFs.

� ANNEX E�Contingency Operations.

� APPENDIX 1�Reaction to Medical Emergency. Prescribe procedure to be followed inthe event of a medical emergency.

� APPENDIX 2�Reaction to Enemy Action. Prescribe the DTF�s response in the eventof enemy action, to include handling of patients within the DTF.

� TAB A�NBC Response.

� TAB B�Ground Attack.

� TAB C�Air Attack.

� APPENDIX 3�Mass Casualty Response. Prescribe the DTF�s responsibilities in theevent of mass casualties.

� ANNEX F�Infection Control. Statement of required infection control procedures.

� APPENDIX 1�Personal and Patient Protection. Prescribe procedure for protection ofhealth care provider and patient.

� APPENDIX 2�Sterilization of Instruments.

� APPENDIX 3�Disposal of Infectious Waste.

� ANNEX G�Relocation. Procedures for emplacement and displacement of the DTF.

� APPENDIX 1�Dental Treatment Facility Setup.

� APPENDIX 2�Dental Treatment Facility Takedown.

� APPENDIX 3�Provision of Dental Treatment During Relocation. Prescribe procedurefor provision of emergency dental treatment during relocation.

� ANNEX H�Safety. Statement of safety policies and procedures.

� APPENDIX 1�X-ray Safety.

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FM 4-02.19

� TAB A�Radiation Exposure Monitoring.

� APPENDIX 2�Fire Safety.

� APPENDIX 3�Hearing Conservation.

� APPENDIX 4�Hazardous Material Handling.

� ANNEX I�Physical Security. Statement of physical security plan for the DTF.

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FM 4-02.19

APPENDIX E

SUGGESTED FORMAT FOR A TACTICAL STANDINGOPERATING PROCEDURE

E-1. General

Paragraphs E-4�E-5 of this appendix discusses TSOP and states the requirement for dental units to haveone. Field Manual 101-5 provides specific guidance on SOP and should be referenced in the developmentof the unit�s TSOP. It is important to reemphasize that the TSOP of the parent unit is the most importantsource of guidance for the TSOP of its subordinates. There is no prescribed format for a TSOP; however,the information contained in the remainder of this appendix offers a suggested format based on the review ofa number of dental unit TSOP currently in use.

E-2. Publication Format

A number of possibilities exist for the format of a TSOP. Three are listed below with advantages anddisadvantages.

� Loose-leaf binder�least expensive and easily updated; however, the requirement for faithfulupdates by users and the potential for pages being lost through hard use is likely to produce a number ofversions among the TSOP users.

� Bound volume�best method to maintain standardization of copies and easiest to handle anduse; however, it is more expensive and subject to availability of a printing facility. It is also difficult toupdate.

� Pocket-sized bound volume�easy to carry and a more ready-reference; however, more easilylost and more difficult to read. Otherwise, pocket-sized bound volume is the same as a standard-sizedbound volume.

E-3. Contents

The TSOP should contain the following sections:

� Directive.

� Table of contents.

� Record of changes and corrections.

� General information.

� Annexes, appendixes, and tabs.

� Index.

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FM 4-02.19

The information contained in each of these sections, other than the table of contents, which is self-explanatory, is variable and will depend on the type of unit and guidance contained in the TSOP of thehigher headquarters.

E-4. Directive

The directive should be the first page of the TSOP. The directive is the letter order signed by thecommander directing implementation of the TSOP. The directive should be in memorandum for-mat (Figure E-1) on unit letterhead for distribution to subordinate units and elements to which the TSOPapplies.

OFFICE SYMBOL (MARKS NUMBER) DATE

MEMORANDUM FOR Personnel Assigned to (Unit Designation)

SUBJECT: (Unit Designation) Tactical Standing Operating Procedure (TSOP)

1. PURPOSE: One sentence statement of purpose.

2. APPLICABILITY: Statement of the unit�s subordinate units and elements to which the TSOP applies.

3. GENERAL: Any administrative information concerning the TSOP deemed necessary such as distribution of copies,where TSOP is to be maintained, and procedure for posting corrections and changes. The scope and content of thisparagraph is a matter of preference; however, it should be a length that allows the entire directive to be a single page.

4. POINT OF CONTACT: Statement of which individual is the point of contact for recommendation of change and othermatters relating to the TSOP.

Figure E-1. Sample format of directive.

E-5. Record of Changes and Corrections

A good TSOP requires regular maintenance to ensure currency and relevance. A page which acts asa record of changes and corrections in the front of the book allows the user and the commander to easilyaudit that particular copy of the TSOP. A single page formatted as shown in Figure E-2 will serve thispurpose.

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RECORD OF CHANGES AND CORRECTIONS

Unit Designation TSOP

NUMBER DESCRIPTION AUTHORITY DATE ENTERED BY_________ ______________ ____________ _____ ______________________ ______________ ____________ _____ ______________________ ______________ ____________ _____ ______________________ ______________ ____________ _____ _____________

Figure E-2. Format for changes and corrections.

E-6. Annexes

Most information relating to a specific procedure or area is incorporated into an annex dealing with thatspecific subject. Annexes are, in turn, supported by appendixes and tabs, as necessary, to the appendixes.As with the entire TSOP, information should not be redundant or voluminous; nevertheless, it must providenecessary guidance in enough detail to perform the prescribed procedure. Annexes address who, what,where, when, and how. They do not address why. Annexes are attached in alphabetical order after thebody of the TSOP. Appendixes are numbered and are attached immediately after the annex they support.Tabs are lettered and are attached immediately after the appendix they support.

a. Formats. Formats for annexes, appendixes, and tabs should be standardized throughout theTSOP. Annexes, appendixes, and tabs do not have signature blocks.

b. Topics. Topics for annexes and their supporting appendixes and tabs depend on a number offactors. Those topics covered in the body of the TSOP need not be repeated unless amplification isrequired. Again, the TSOP of the parent headquarters is the best guide. Other topics to be considered arethose topics specifically cited in this FM as being matters that should be included in the unit TSOP.Individual soldier tasks critical to unit operations and survival should also be considered for inclusion.

E-7. Index

A well-constructed, comprehensive index of the material contained in the TSOP and its supporting annexes,appendixes, and tabs is a valuable complement to the TSOP. The addition of an index facilitates use of theTSOP, particularly its use as a ready reference.

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FM 4-02.19

APPENDIX F

FORCE PROTECTION STRATEGIC DEPLOYABILITY DATA FOR DENTAL SERVICE SUPPORT

F-1. General

This appendix provides strategic deployability data for DSS for MRI units. It is only a general referenceand must be tailored to the specific unit and equipment.

F-2. Strategic Deployability Data

Table F-1 provides strategic deployability data for Dental Service Support, MRI units.

Table F-1. Dental Service Support Medical Detachment Data for MRI Units

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GLOSSARY

ABBREVIATIONS, ACRONYMS, AND DEFINITIONS

AAR after-action report

ABCA American, British, Canadian, and Australian

ACR armored cavalry regiment

ADL area dental laboratory(ies)

AMEDD Army Medical Department

AMEDDC&S Army Medical Department Center and School

AO area of operations

AOC area of concentration

AOR area of responsibility

AR Army regulation

ASMB area support medical battalion

ASMC area support medical company

ATM advanced trauma management

attn attention

BI battle injury

bn battalion

BOA basis of allocation

BTOE base table(s) of organization and equipment

C2 command and control

CHL combat health logistics

CHS combat health support

co company

Glossary-2

FM 4-02.19

COMMZ communications zone

CONUS continental United States

CSH combat support hospital

CSOP clinical standing operating procedure

CSS combat service support

CTA common table(s) of allowance

CZ combat zone

DA Department of the Army

DCAS dental company area support

DCEP Dental Combat Effectiveness Program

DD/DOD Department of Defense

DE directed energy

DEN dental

DEPMEDS Deployable Medical Systems

DES dental equipment set(s)

det detachment

DISCOM division support command

DISE Distribution Illumination System, Electric

DISS dental instrument and supply set(s)

DMS dental materiel set(s)

DNBI disease and nonbattle injury

DS direct support

Glossary-3

FM 4-02.19

DSS dental service support

DTF dental treatment facility

EAC echelons above corps

Echelons of medical care:

Echelon I. The first medical care a soldier receives is provided at this echelon. This care includesimmediate lifesaving measures, disease and nonbattle injury prevention, combat stress controlpreventive measures, casualty collection, evacuation from supported unit to supporting medicaltreatment facility, and treatment provided by designated individuals or treatment squads. Echelon Ielements are located throughout the combat zone and the communications zone. These elementsinclude self-aid/buddy aid, the combat lifesavers, the combat medics, and the physicians and physiciansassistants.

Echelon II. Duplicates Echelon I and expands services available by adding dental, laboratory, x-ray,and patient-holding capabilities. Emergency care (advanced trauma management), including beginningresuscitation procedures is continued. (No general anesthesia is available.) If necessary, additionalemergency measures are instituted; however, they do not go beyond the measures dictated by theimmediate need. Those patients who can return to duty within 72 hours are held for treatment. Theabove functions are performed by medical companies organic to�

� Support battalions of separate maneuver brigades.

� Support squadrons of armored cavalry regiments.

� Support battalions of division support commands.

� Medical companies of medical battalions (area support) (corps and communicationszone).

Echelon III. This echelon of care expands the support provided at Echelon II (division Echelon).Care is provided for all categories of patients in a medical treatment facility with the proper staff andequipment. Patients who are unable to tolerate and survive movement over long distances will receiveimmediate surgical care in hospitals as close to the division rear boundary as the tactical situation willallow. Surgical care may be provided within the division area under certain operational conditions.Echelon III hospital care is provided by the combat support hospital.

Echelon IV. This echelon of care includes treating the patient in a combat support hospital staffedand equipped for general and specialized medical and surgical care. The combat support hospital andmedical company may also be deployed in the communications zone to support rear operationscontingencies. The combat support hospital provides hospitalization for general classes of patients andreconditioning and rehabilitative services for those patients who can return to duty within the theater

Glossary-4

FM 4-02.19

evacuation policy. It serves as the primary conduit for patient evacuation to the continental UnitedStates. (For additional information on the echelons of medical care, refer to FM 8-10.)

EPW enemy prisoner(s) of war

fax facsimile

FH field hospital

FM field manual

FMC field medical card

FSB forward support battalion

FSMC forward support medical company

ft feet

fwd forward

G1 Assistant Chief of Staff (Personnel)

GH general hospital

GWS Geneva Convention for the Amelioration of the Condition of the Wounded and Sick

HA Health Affairs

HHD headquarters, headquarters detachment

HQ headquarters

J-TMIP Joint Theater Medical Information Program

kV kilovolts

kW kilowatts

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FM 4-02.19

lbs pounds

LMSR large medium-speed roll-on/roll-off

mA milliamperes

MC4 medical communications for combat casualty care

MED medical/medium

MEDCOM medical command

MEDLOG medical logistics

METL mission essential task list

METT-TC mission, enemy, terrain, troops, time available, and civilian considerations

MF2K Medical Force 2000

MMS medical materiel sets

MOPP mission-oriented protective posture

MOS military occupational specialty

MRI Medical Reengineering Initiative

MSB main support battalion

MSMC main support medical company

MSR main supply route

MTF medical treatment facility

MTOE modified table of organization and equipment

MWD military working dog

NATO North Atlantic Treaty Organization

NBC nuclear, biological, and chemical

NCO noncommissioned officer

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FM 4-02.19

NCOIC noncommissioned officer in charge

OBJ objective

OIC officer in charge

OPLAN operation plan

OPORD operation order

Pam pamphlet

PAX passenger

PLL prescribed load list

pros prosthetics

PVNTMED preventive medicine

QSTAG Quadripartite Standardization Agreement

RDD radiological dispersal device(s)

RORO roll-on/roll-off

RTD return to duty

S1 Adjutant

SF standard form

SFG special forces group

sm small

SOP standing operating procedure

spt support

Glossary-7

FM 4-02.19

sq square

SRC standard requirement code

SSPLAN service support plan

STANAG standardization agreement

STD standard

STP Soldier Training Publication

svc service

TB MED technical bulletin, medical

TM technical manual/team

TO theater of operations

TOE table(s) of organization and equipment

trmt treatment

TSOP tactical standing operating procedure

US United States

WARNO warning order

References-1

FM 4-02.19

REFERENCES

SOURCES USED

These are the sources quoted or paraphrased in this publication.

NATO STANAGs

These agreements are available on request using DD Form 1425 from Standardization Document OrderDesk, 700 Robin Avenue, Building 4, Section D, Philadelphia, Pennsylvania 19111-5094.

2014. Warning Orders, Operation Orders, and Administrative Service Support Orders. 26 May 1998.2068. Emergency War Surgery. Edition 4. 28 October 1986. (Latest Amendment, 17 October 1991.)2122. Medical Training in First Aid, Basic Hygiene, and Emergency Care. Edition 2. (Latest Amendment,

7 January 1999.)2127. Medical, Surgical, and Dental Instrument, Equipment. Edition 3. 28 February1989. (Latest Amend-

ment, 31 May 1995.)2128. Medical and Dental Supply Procedures. Edition 4. 21 November 1991.2454. Regulation and Procedures for Road Movement and Identification of Movement Control and Traffic

Control Personnel and Agencies. Edition 1. 6 July 1998.2931. Orders for the Camouflage of the Red Cross and Red Crescent on Land in Tactical Operations.

Edition 2. 19 January 1998. (Latest Amendment, 3 April 1998.)

ABCA QSTAGs

These agreements are available on request using DD Form 1425 from Standardization Document OrderDesk, 700 Robin Avenue, Building 4, Section D, Philadelphia, Pennsylvania 19111-5094.

322. Emergency War Surgery. 19 December 1986.520. Operation Orders, Tables, and Graphs for Road Movement. October 1981.535. Medical Training in First Aid, Basic Hygiene and Emergency Care. 27 February 1990.536. Medical, Surgical, and Dental Instruments, Equipment, and Supplies. 27 February 1990.

DOCUMENTS NEEDED

These documents must be available to the intended users of this publication.

Joint and Multiservice Publications

*FM 3-3. Chemical and Biological Contamination Avoidance. FMFM 11-17. 16 November 1992.(Change 1, 29 September 1994.)

*This source was also used to develop this publication.

References-2

FM 4-02.19

FM 3-4. NBC Protection. FMFM 11-9. 29 May 1992. (Reprinted with basic including Change 1,28 October 1992; Change 2, 21 February 1996.)

FM 3-5. NBC Decontamination. MCWP3-37.3. 28 July 2000.*FM 8-9 (4-02.11). NATO Handbook on the Medical Aspects of NBC Defensive Operations AMEDP-6 (B),

Part I�Nuclear, Part II�Biological, Part III�Chemical. NAVMED P-5059; AFJMAN 44-151V1V2V3. 1 February 1996.

*FM 8-33 (4-02.33). Control of Communicable Diseases Manual (16th Edition). NAVMED P-5038.9 April 1996.

*FM 8-284 (4-02.284). Treatment of Biological Warfare Agent Casualties. NAVMED P-5042; AFMAN(I)44-156; MCRP 4-11.1C. 17 July 2000.

*FM 8-285 (4-02.285). Treatment of Chemical Agent Casualties and Conventional Military ChemicalInjuries. NAVMED P-5041; AFJMAN 44-149; FMFM 11-11. 22 December 1995.

Army Regulations (AR)

40-3. Medical, Dental, and Veterinary Care. 30 July 1999.40-35. Preventive Dentistry. 26 March 1989.40-61. Medical Logistics Policies and Procedures. 25 January 1995.40-66. Medical Record Administration and Health Care Documentation. 3 May 1999.*40-68. Quality Assurance Administration. 20 December 1989.71-32. Force Development and Documentation�Consolidated Policies. 3 March 1997.385-55. Prevention of Motor Vehicle Accidents. 12 March 1987.600-8-101. Personnel Processing (In-and-Out and Mobilization Processing). 12 December 1989. (Re-

printed with basic including Change 1, 26 February 1993; Change 2, 1 March 1997.)710-2. Inventory Management Supply Policy Below the Wholesale Level. 31 October 1997.750-1. Army Materiel Maintenance Policy and Retail Maintenance Operations. 1 August 1994. (Change 1

1 July 1996.)

Department of the Army Pamphlets (DA Pam)

710-2-1. Using Unit Supply System (Manual Procedures). 31 December 1997.738-750. Functional Users Manual for the Army Maintenance Management System (TAMMS). 1 August

1994.

Field Manuals (FM)

8-10 (4-02). Health Service Support in a Theater of Operations. 1 March 1991.8-10-1 (4-02.6). The Medical Company�Tactics, Techniques, and Procedures. 29 December 1994.8-10-6 (4-02.2). Medical Evacuation in a Theater of Operations�Tactics, Techniques, and Procedures.

14 April 2000.8-10-7 (4-02.7). Health Service Support in a Nuclear, Biological, and Chemical Environment. 22 April

1993. (Change 1, 26 November 1996.)

References-3

FM 4-02.19

8-10-14 (4-02.14). Employment of the Combat Support Hospital�Tactics, Techniques, and Procedures.29 December 1994.

8-10-15 (4-02.15). Employment of the Field and General Hospitals�Tactics, Techniques, and Procedures.26 March 1997.

8-42 (4-02.42). Combat Health Support in Stability Operations and Support Operations. 27 October 1997.8-50 (4-02.50). Prevention and Medical Management of Laser Injuries. 8 August 1990.8-55 (4-02.55). Planning for Health Service Support. 9 September 1994.21-10 (4-25.10). Field Hygiene and Sanitation. 21 June 2000.21-10-1 (4-25.12). Unit Field Sanitation Team. 11 October 1989.24-1. Signal Support in the AirLand Battle. 15 October 1990.100-14. Risk Management. 23 April 1998.100-17. Mobilization, Deployment, Redeployment, Demobilization. 28 October 1992.101-5. Staff Organization and Operations. 31 May 1997.

Soldier Training Publications (STP)

21-1-SMCT. Soldier�s Manual of Common Tasks Skill Level 1. 1 October 1994.

Technical Bulletin (TB)

38-750-2. Maintenance Management Procedures for Medical Equipment. 12 April 1987. (Reprinted withbasic including Changes 1�3, 1 November 1989.)

Technical Bulletins, Medical (TB MED)

250. Recording Dental Examinations, Diagnosis and Treatments, and Appointment Control. 28 February 1990.266. Disinfection and Sterilization of Dental Instruments and Materials. 31 May 1995.

Department of the Army Forms (DA Form)

3161. Request for Issue or Turn-In. May 1983.3444 Series. Terminal Digit File for Treatment Record. May 1991.

Department of Defense Form (DD/DOD Form)

1380. US Field Medical Card. December 1991.

Standard Form (SF)

603A. Health Records�Dental Continuation. October 1975.

References-4

FM 4-02.19

Common Tables of Allowances (CTA)

50-900. Clothing and Individual Equipment. 1 September 1994.

READINGS RECOMMENDED

These documents contain relevant supplemental information.

Joint and Multiservice Publication

FM 100-20. Military Operations in Low Intensity Conflict. AFP 3-20. 5 December 1990.

Army Regulations (AR)

11-9. The Army Radiation Safety Program. 28 May 1999.25-50. Preparing and Managing Correspondence. 21 November 1988.25-400-2. The Modern Army Recordkeeping System (MARKS). 26 February 1993.40-5. Preventive Medicine. 15 October 1990.190-11. Physical Security of Arms, Ammunition, and Explosives. 30 September 1993. (Change 1,

12 February 1998.)220-1. Unit Status Reporting. 1 September 1997.220-45. Duty Rosters. 15 November 1975.310-25. Dictionary of United States Army Terms (Short Title: AD). 15 October 1983. (Reprinted

with basic including Change 1, 21 May 1986.)310-50. Authorized Abbreviations and Brevity Codes. 15 November 1985.*385-10. The Army Safety Program. 23 May 1988. (Change 1, 29 February 2000.)385-40. Accident Reporting and Records. 1 November 1994.600-8-22. Military Awards. 25 February 1995.614-200. Enlisted Assignments and Utilization Management. 31 October 1997.623-105. Officer Evaluation Reporting System. 1 October 1997. (Change 1, 1 April 1998.)623-205. Enlisted Evaluation Reporting System. 31 March 1992.700-138. Army Logistics Readiness and Sustainability. 16 September 1997.

Department of the Army Pamphlets (DA Pam)

25-30. Consolidated Index of Army Publications and Blank Forms. (Issued Quarterly.) 1 October 2000.40-13. Training in First Aid and Emergency Medical Treatment. 22 August 1985.40-501. Hearing Conservation Program. 10 December 1998.

Field Manuals (FM)

3-100. Chemical Operations Principles and Fundamentals. MCWP 3-3.7.1. 8 May 1996.

References-5

FM 4-02.19

8-10-4 (4-02.4). Medical Platoon Leaders� Handbook�Tactics, Techniques, and Procedures. 16November l990.

8-10-9 (4-02.9). Combat Health Logistics in a Theater of Operations�Tactics, Techniques, andProcedures. 3 October 1995.

8-51 (4-02.51). Combat Stress Control in a Theater of Operations�Tactics, Techniques, and Proce-dures. 29 September 1994. (Change 1, 30 January 1998.)

9-43-1. Maintenance Operations and Procedures. 21 February 1997.10-64. Mortuary Affairs Operations. 16 February 1999.19-30. Physical Security. 1 March 1979.21-11 (4-25.11). First Aid for Soldiers. 27 October 1988. (Reprinted with basic including Changes

1�2, 4 December 1991.)21-20. Physical Fitness Training. 30 September 1992. (Change 1, 1 October 1998.)21-76. Survival. 5 June 1992.22-51 (4-02.22). Leaders� Manual for Combat Stress Control. 29 September 1994.25-4. How to Conduct Training Exercises. 10 September 1984.25-5. Training for Mobilization and War. 25 January 1985.25-100. Training the Force. 15 November 1988.25-101. Battle Focused Training. 30 September 1990.27-10. The Law of Land Warfare. 18 July 1956. (Reprinted with basic including Change 1, 15 July 1976.)55-30. Army Motor Transport Units and Operations. 27 June 1997. (Change 1, 15 September 1999.)100-5. Operations. 14 June 1993.

Supply Bulletins (SB)

8-75-Series. These bulletins provide Army Medical Department supply information.

Technical Manuals (TM)

9-6150-226-13. Operator, Unit, and Direct Support Maintenance Manual for Distribution IlluminationSystem, Electrical (DISE) and Power Distribution Illumination System, Electrical (PDISE).30 May 1991. (Reprinted with basic including Changes 1�4, 1 July 1997.)

9-6150-226-23P. Unit and Director Support Maintenance Repair Parts and Special Tools List forDistribution Illumination System, Electrical (DISE) and Power Distribution IlluminatingSystem, Electrical (PDISE). 13 April 1992. (Change 3, 30 June 1997.)

Department of Defense Publications (DD/DOD Form)

CMH Pub 83-3. Emergency War Surgery: Second United States Revision of the Emergency War SurgeryNATO Handbook. 1988.

Code of Federal Regulations (1910.1200). Hazard Communication.DOD 6050.5-W. DOD Hazard Communication Training Program. April 1988.

References-6

FM 4-02.19

Department of the Army Forms (DA Form)

12-R. Request for Establishment of a Publication Account (LRA). April 1996.1594. Daily Staff Journal or Duty Officer�s Log. 1 November 1962.2406. Materiel Condition Status Report. April 1993.2715-R. Unit Status Report (LRA). April 1996.4187. Personnel Action. January 2000.4691-R. Initial Application for Clinical Privileges (LRA). July 1989.5374-R. Performance Assessment (LRA). July 1989.5440-1-R. Delineation of Privileges-Dentistry (LRA). June 1991.5441-1-R. Evaluation of Privileges-Dentistry (LRA). July 1989.5754-R. Malpractice and Privileges Questionnaire (LRA). June 1991.

Technical Bulletin, Medical (TB MED)

521. Occupational and Environmental Health: Management and Control of Diagnostic, Therapeutic, andMedical Research X-Ray Systems and Facilities. 2000.

Index-1

FM 4-02.19

INDEX

References are to paragraph numbers except where specified otherwise.

additional wartime roles, 4-20a, Chapter 8casualty encounters, 8-6in mass casualty operations, 8-4�7planning for, 8-7roles of dental officer, 8-4�5training for, 8-2

administration and logistics, 4-21after-action report (documentation), 4-31area dental support, 2-2, 2-6c, 3-8

classes of supply, 10-4classification of dental patients, Appendix Bclinical standing operating procedure (CSOP), 3-13, 4-5b, Appendix Dcombat health support, 1-3�4, 2-2�4, 4-1�2, 4-9, 4-11, 4-20�21, 4-23, 4-26, 5-4, 5-8, 6-3, 9-3, A-2�3

communications, 5-8dental service support, 1-3echelons of, 1-2, 1-4, 4-23GWS, 4-26principles of, 4-11support arrangements, 4-23

command and control, 5-1�3command channels, 5-12interim relationships, 5-6relationships, 5-6technical control, 5-5

communications, 5-10alternative means of, 5-10equipment for, 5-10external support for, 5-9technical channel, 5-12c

comprehensive care, 1-4convoy operations, 4-14

daily dental unit status report, 3-14e and g, 5-14bdecontamination, 9-15, 9-18dental

care, categories of, 1-4classifications, Appendix Bcombat effectiveness program, 3-15cequipment, field, 3-4�7information, types of, 5-13radiology, 3-19, C-6, D-7

Index-2

FM 4-02.19

dental (continued)records and reports, 3-14service support

deployability data, Appendix Fechelons of care, 1-2, 6-6in stability operations and support operations, 7-3mission, 1-1, 2-1overview, Chapter 1phased employment of, 6-4planning for stability operations and support operations, 7-4types of, 2-2within a TO, 2-6

staff officer, 2-4�5status report, 5-14bsurgeon, 2-3, 2-5, 4-9, 5-7

medical command, 2-3treatment facility

daily dental treatment log, 3-14cdental log, 3-14bprotection and identification of, 4-26c, D-7site selection, 3-9

dentistry/prosthetics section, 2-8, 3-11aDeployable Medical Systems, 3-4, 3-7directed-energy. See nuclear, biological, and chemical.documentation (after-action reporting), 4-31

echelons of medical care, 1-2, Glossary-3�4emergency

care, 1-4equipment for, 3-6arate, 3-15c

enemyprisoners of war, 4-19threat, 4-26

equipment, dental, field. See field dentistry.essential care, 1-4evacuation of dental patients, 2-6a(2), 3-3

fielddentistry, 3-1

dentalequipment, 3-4�6treatment facilities, 3-11

power generation and distribution, 3-11shelter, 3-10

oral hygiene information program, 3-15a

Index-3

FM 4-02.19

fire safety, D-7forward dental treatment section, 3-11b

medicalcompany, 2-10a(4), 3-11adetachment, 2-9

general dentistry section,medical

company (dental service), 2-8, 3-11detachment (dental service), 2-9, 3-11

Geneva Conventions, 4-26. See also Laws of Land Warfare.enemy prisoners of war, 4-19b

headquarters and headquarters detachment, medical battalion (dental service), 2-7roles of, 10-7b

hearing conservation, D-7hospital dental support, 2-2, 2-6b, 3-7

equipment for, 3-7layout, 3-11mission of, 2-6borganization, 2-6b(1)

humanitarian assistance and civic action, 4-19c, 7-1

infection control, 3-16, D-7disposal of waste, 3-18waste management, 3-18

interim relationships, 5-6

laboratory operations, 3-22bLaws of Land Warfare, 4-26, 5-3

maintenance, 10-1, 10-7materiel readiness reporting, 10-8personnel, 10-2preventive, 10-9support, 10-7system, Army, 10-8vehicle maintenance, 10-7

mass casualty operations, 1-1b, 1-3, 4-20, 8-1, 8-4�7, 9-18planning for, 8-7

maxillofacialequipment for, 3-7cin an NBC environment, 9-20cinjuries, 1-1b, 9-20c,surgery, 2-6b(4)

Index-4

FM 4-02.19

medicalbattalion (dental service), 2-7, 3-8, 6-1�2

employment inCOMMZ, 6-3CZ, 6-1

headquarters and headquarters detachment, 2-7command, 2-5dcompany (dental service), 2-3, 2-8, 3-8, 4-23, 6-2�3

dentistry/prosthetics section, 2-8, 3-11aemployment of, 6-2�3forward dental treatment section, 2-8, 3-11bgeneral dentistry section, 2-8headquarters and support section, 2-8

detachment (dental service), 2-9, 3-8, 6-3employment of, 6-4forward dental treatment section, 2-9, 3-11bgeneral dentistry section, 2-9headquarters and support section, 2-9

evacuation, 3-3reengineering initiative, Appendix Asupply

classes of, 10-4operations, 10-5

teamhead and neck surgery, 2-6b(4)prosthodontics, 2-7�8, 2-10, 3-20�22

threat, 4-3, 4-25dental threat, 4-3belements of, 4-3athreat analysis, 4-3

movement(s)convoy operations, 4-14plans, 4-15�17strategic, 4-12vehicle load plans, 4-17within the TO, 4-13unit, 4-11, 4-16�17

nuclear, biological, and chemical, 9-1casualties in, 9-5�8decontamination, 9-15, 9-19defense from, 9-10�13dental mission in, 9-2directed-energy environment, 9-9equipment, 9-12

Index-5

FM 4-02.19

nuclear, biological, and chemical (continued)maxillofacial injuries, 9-20cmission-oriented protective posture, 9-17, 9-20boperations in, 9-16patient

care in, 9-19protection, 9-20

technical guidance, 9-3

operationalcare, 1-4continuum, 4-2atasks, dental, 4-4

orders, 4-8, 4-10administration, 4-8acombat, 4-8b

patientpopulation, 4-19records, 3-14dtreatment data, 5-14

peacekeeping operations, Chapter 7planning process, 4-7, 4-10

for additional wartime roles, 8-5in stability operations and support operations, 7-4

preventivedental specialist, 3-6e, 3-19bdentistry, 3-15medicine, 3-18, 4-3

prosthodontics, 2-10, 3-11, 3-21capabilities of, 3-22clinical operations, 3-22aequipment set, 3-6glaboratory operations, 3-22bmedical team (prosthodontics), 3-8, 3-22

protection, patient and care provider, 3-17, 9-20, 4-26

Quadripartite Standardization Agreement(s), Preface, 3-4quality assurance, Appendix C

credentials/privileges, C-1in the theater of operation, C-2patient care evaluation, C-3radiology, C-6risk management, C-5utilization management, C-4

quarterly dental activities report, 3-15f

Index-6

FM 4-02.19

radiology operations, 3-19, C-6, D-7rear area operations, 4-27reconstitution, 4-30records and reports, 3-14, C-6crecovery procedures, 4-28

after-action report, 4-31redeployment, 4-28�29referral of dental patients, 3-3brisk management, C-5

safety, 4-26e, C-5shelter, types of, 3-10stability operations and support operations, 4-19c, Chapter 7

dental support in, 7-3employment of dental personnel, 7-4imperatives, 7-2bplanning for, 7-4

staff officer, dental, 2-15, 4-9positions, 2-5responsibilities of, 2-4

Standardization Agreements, Preface, 3-4, 4-26standing operating procedures, 4-5

clinical, 3-13, 4-5b, Appendix Dtactical, 4-5b, 4-16, 4-28, Appendix E

supply, 10-1�3classes of, 10-4medical supply, 10-5personnel, 10-2unit supply operations, 10-6

support arrangements, types of, 4-23sustainment of dental operations, 4-21

planning for, 4-22support, 4-23

tactical standing operation procedure, 4-5b, 4-16, 4-25c, 4-28, 4-31, Appendix Ethreat

dental, 4-3benemy, 4-25medical, 4-3, 4-25NBC, 4-25a

training, 4-4for wartime roles, 8-2�4

unitdental support, 2-6movements, 4-11�17

Index-7

FM 4-02.19

unit (continued)status report, 3-14e, Figure 5-2supply operations, 10-6

utilization management, C-4

vehicle load plans, 4-17, D-7veterinary support, 4-20b

x-ray operations, 3-19processing, D-7protection plan, D-7quality assurance for, C-7shielding for, C-6

FM 4-02.19 (FM 8-10-19) 1 MARCH 2001

By Order of the Secretary of the Army:

ERIC K. SHINSEKI General, United States Army Chief of Staff

Official:

JOEL B. HUDSONAdministrative Assistant to the

Secretary of the Army 0101103

DISTRIBUTION:

Active Army, US Army Reserve, and Army National Guard: To be distributed in accordancewith the initial distribution number 115231, requirements for FM 4-02.19.

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